To link to the entire object, paste this link in email, IM or documentTo embed the entire object, paste this HTML in websiteTo link to this page, paste this link in email, IM or documentTo embed this page, paste this HTML in website

North Carolina Study Commission on Aging : report to the ... General Assembly of North Carolina ... Session

North Carolina Study Commission on Aging : report to the ... General Assembly of North Carolina ... session.

NORTH CAROLINA
STUDY COMMISSION ON AGING
REPORT TO THE
GOVERNOR AND THE 2008 REGULAR SESSION OF THE
2007 GENERAL ASSEMBLY
A LIMITED NUMBER OF COPIES OF THIS REPORT IS AVAILABLE
FOR DISTRIBUTION THROUGH THE LEGISLATIVE LIBRARY.
ROOMS 2126, 2226
STATE LEGISLATIVE BUILDING
RALEIGH, NORTH CAROLINA 27611
TELEPHONE: ( 919) 733- 7778
OR
ROOM 500
LEGISLATIVE OFFICE BUILDING
RALEIGH, NORTH CAROLINA 27603- 5925
TELEPHONE: ( 919) 733- 9390
North Carolina
Study Commission On Aging
May 12, 2008
To: Governor Michael Easley
Lieutenant Governor Beverly Perdue, President of the North Carolina Senate
Senator Marc Basnight, President Pro Tempore of the North Carolina Senate
Representative Joe Hackney, Speaker of the North Carolina House of Representatives
Members of the 2008 Regular Session of the 2007 General Assembly
Attached is a report from the North Carolina Study Commission on Aging submitted pursuant to
North Carolina General Statute § 120- 187. The report contains recommendations and proposed
legislation from the North Carolina Study Commission on Aging based on study conducted after
the adjournment of the 2007 Regular Session of the General Assembly.
Respectfully submitted,
___________________________ ___________________________
Senator Vernon Malone Representative Jean Farmer- Butterfield
Co- Chair Co- Chair
1
North Carolina Study Commission On Aging
2007- 2008 Membership List
President Pro Tempore's Appointments Speakers' Appointments
Senator Vernon Malone, Co- Chair Representative Jean Farmer- Butterfield, Co- Chair
Senator Stan Bingham Representative Alice Bordsen
Senator Katie Dorsett Representative Joe Boylan
Senator James Forrester Representative Bob F. England, MD
Senator A. B. Swindell, IV Representative Garland Pierce
Mr. Anthony Peace Ms. Karen Gottovi
Mr. Judy Pelt Mr. David Lowa
Ms. Jean Reaves Mr. Edd Nye
Ex Officio:
Mr. Jackie Sheppard, Assistant Secretary,
Long Term Care and Family Services,
Department of Health and Human Services
Clerks:
Bonnie McNeil
919/ 733- 5880
Ruth Merkle
919/ 733- 5898
Staff:
Theresa Matula,
Shawn Parker,
Ben Popkin
Research Division
919/ 733- 2578
2
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 3
TABLE OF CONTENTS
LETTER OF TRANSMITTAL...................................................................................................... 1
MEMBERSHIP LIST...................................................................................................................... 2
PREFACE ............................................................................................................................... ........ 6
EXECUTIVE SUMMARY ............................................................................................................. 7
AGING NORTH CAROLINA: THE 2008 PROFILE ................................................................ 11
COMMISSION PROCEEDINGS .................................................................................................. 20
COMMISSION RECOMMENDATIONS..................................................................................... 26
APPENDICES
APPENDIX A.............................................................................................................................. .... 44
2007 Recommendation Status Report
Summary of Substantive Legislation Related to Aging, 2006 Session
APPENDIX B ............................................................................................................................... .. 67
Summary of Issues Most Frequently Mentioned by Organizations Representing Older Adults
APPENDIX C ............................................................................................................................... .. 73
Summary of 2008 Public Hearings
APPENDIX D.............................................................................................................................. .... 77
Legislative Proposals/ Bills
2007- SHZ- 23 AN ACT TO APPROPRIATE ADDITIONAL FUNDS TO THE SENIOR CENTER
GENERAL PURPOSE FUND, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2007- SHZ- 24 AN ACT TO APPROPRIATE ADDITIONAL FUNDS FOR THE HOME AND
COMMUNITY CARE BLOCK GRANT, AS RECOMMENDED BY THE NORTH CAROLINA
STUDY COMMISSION ON AGING.
2007- SHZ- 25 AN ACT TO APPROPRIATE FUNDS FOR PROJECT C. A. R. E. ( CAREGIVER
ALTERNATIVES TO RUNNING ON EMPTY) WHICH PROVIDES CONSUMER- DIRECTED
RESPITE CARE AND COMPREHENSIVE SUPPORT TO DEMENTIA CAREGIVERS WITH A
GOAL OF INCREASING RESPITE AND SUPPORT SERVICES TO LOW- INCOME RURAL AND
MINORITY CAREGIVERS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2007- SHZ- 26 AN ACT TO APPROPRIATE FUNDS TO ENACT A PILOT PROGRAM TO ASSESS
CHANGES PROPOSED BY THE ADULT PROTECTIVE SERVICES TASKFORCE WITH A GOAL
OF IMPROVING NORTH CAROLINA'S SYSTEM OF RESPONDING TO ALLEGATIONS OF
ABUSE, NEGLECT, EXPLOITATION, OR SUBSTANTIAL RISK OF VULNERABLE OR ELDER
ADULTS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 4
2007- SHZ- 29 AN ACT TO PROVIDE A COMPREHENSIVE FIVE- YEAR STATEWIDE STUDY OF
THE STATE'S READINESS TO RESPOND TO THE COMING WAVE OF OLDER ADULTS BY
ESTABLISHING A STEERING COMMITTEE FOR THE STUDY, APPROPRIATING FUNDS TO
PROVIDE STAFF TO SUPPORT THE COMMITTEE, AND APPROPRIATING FUNDS FOR THE
FIRST YEAR OF THE STUDY, AS RECOMMENDED BY THE STUDY COMMISSION ON
AGING.
2007- SHZ- 31 AN ACT TO APPROPRIATE FUNDS FOR AN ADULT CARE HOME SCREENING
PROCESS FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITY CONDITIONS,
APPROPRIATE FUNDS FOR TRANSITIONAL RESIDENTIAL TREATMENT PROGRAM PILOT
SITES, APPROPRIATE FUNDS TO SUPPORT ASSESSMENT AND SERVICE PLAN
DEVELOPMENT IN ADULT CARE HOMES, AND TO STUDY SUITABLE METHODS TO
PROVIDE DIRECT CARE WORKERS WITH TARGETED AND COST EFFECTIVE TRAINING ON
THE CARE OF INDIVIDUALS WITH MENTAL ILLNESS, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
2007- SQZ- 11 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
STUDY ISSUES RELATING TO RESPITE CARE, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
2007- SQZ- 12 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
STUDY ISSUES RELATING TO HEARING LOSS IN OLDER ADULTS IN NORTH CAROLINA,
AS RECOMMENDED BY THE STUDY COMMISSION ON AGING.
2007- RDZ- 26 AN ACT TO AUTHORIZE THE NORTH CAROLINA STATE BOARD OF EXAMINERS
FOR NURSING HOME ADMINISTRATORS TO OBTAIN CRIMINAL HISTORY RECORD
CHECKS OF APPLICANTS FOR LICENSURE AS NURSING HOME ADMINISTRATORS, AS
RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2007- SHZ- 27 AN ACT TO RAISE THE CEILING ON THE TOTAL AMOUNT OF PERSONAL
PROPERTY A GUARDIAN IS ALLOWED TO SELL WITHOUT A COURT ORDER UNDER THE
LAWS PERTAINING TO GUARDIANSHIP, AS RECOMMENDED BY THE HOUSE STUDY
COMMITTEE ON STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.
2007- SHZ- 28 AN ACT AUTHORIZING THE DIVISION OF MOTOR VEHICLES TO CONSIDER
RECOMMENDATIONS FROM THE CLERK OF COURT IN DETERMINING WHETHER TO
REVOKE THE DRIVERS LICENSE OF A PERSON ADJUDICATED INCOMPETENT UNDER THE
GUARDIANSHIP LAWS, AS RECOMMENDED BY THE HOUSE STUDY COMMITTEE ON
STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.
HB 93 AN ACT TO DIRECT THE DEPARTMENT OF TRANSPORTATION TO STUDY ISSUES
RELATING TO INDIVIDUALS BEING TRANSPORTED IN VEHICLES WHILE SEATED IN
WHEELCHAIRS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
AGING.
HB 92 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
REVIEW OPTIONS FOR INCREASING MEDICAID MEDICALLY NEEDY INCOME LIMITS, AS
RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2007- SQFZ- 14 AN ACT TO INCREASE THE LONG TERM CARE INSURANCE TAX CREDIT, AS
RECOMMENDED BY THE STUDY COMMISSION ON AGING.
2007- SQFZ- 15 AN ACT TO REQUIRE MULTIUNIT ASSISTED HOUSING WITH SERVICES ( MAHS)
PROGRAMS TO REGISTER ANNUALLY WITH THE DIVISION OF HEALTH SERVICE
REGULATION AND TO AUTHORIZE THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES TO ESTABLISH CERTAIN FEES, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 5
2007- SHZ- 30 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES,
DIVISION OF AGING AND ADULT SERVICES, AND DIVISION OF MEDICAL ASSISTANCE,
TO STUDY IMPLEMENTATION OF AN INCOME DISREGARD POLICY FOR CURRENT
STATE/ COUNTY SPECIAL ASSISTANCE AND MEDICAID RECIPIENTS WHO ARE
ADVERSELY IMPACTED DUE TO COST OF LIVING OR OTHER INCOME INCREASES, AS
RECOMMENDED BY THE STUDY COMMISSION ON AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 6
PREFACE
Chapter 120, Article 21, of the North Carolina General Statutes, charges the North Carolina Study
Commission on Aging with studying and evaluating the existing system of delivery of State
services to older adults, and recommending an improved system of delivery to meet the present and
future needs of older adults. The Commission consists of 17 members. Of these members, eight
are appointed by the Speaker of the House of Representatives, eight are appointed by the President
Pro Tempore of the Senate. The Secretary of the Department of Health and Human Services, or the
Secretary’s designee, serves as an ex officio, non- voting member.
This report represents the work of the North Carolina Study Commission on Aging during the 2007-
2008 interim. The Commission met on five occasions and held public hearings in Wilson and
Jamestown. During a meeting on February 28, 2008, the Commission heard brief presentations on
issues of interest or concern to organizations that represent older adults. The public hearings,
conducted in March and April, provided citizens with an opportunity to speak to Commission
members about programs and services for older adults. Based on reports received by the
Commission, input from organizations that represent older adults, and comments expressed by
citizens, the Study Commission on Aging presents the recommendations contained in this report.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 7
EXECUTIVE SUMMARY
The North Carolina Study Commission on Aging met five times and conducted two public hearings
during the 2007- 2008 interim. In response to the study and evaluation of services to older adults,
the North Carolina Study Commission on Aging makes the following recommendations to the
Governor and the 2008 Session of the 2007 General Assembly:
Recommendation 1: Senior Center Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent
that it shall become part of the continuation budget.
Recommendation 2: Additional HCCBG Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 2,500,000 to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the
Home and Community Care Block Grant ( HCCBG).
Recommendation 3: Funds for Project C. A. R. E.
The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000 to
the Department of Health and Human Services, Division of Aging and Adult Services, for the 2008-
2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) which
provides support to individuals with dementia and their caregivers.
Recommendation 4: Adult Protective Services Pilot Program
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087
to the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed changes
to the adult protective services statutes and to report to the Study Commission on Aging on the
evaluation of the pilot by March 1, 2010.
Recommendation 5: Statewide Aging Study
The Study Commission on Aging recommends support for a comprehensive, five- year statewide
study of the older adult population and the State's readiness to respond to the coming wave of older
adults by recommending that the General Assembly take the following steps: establish an
appointment process for a steering committee; appropriate $ 175,000 to the Department of Health
and Human Services, Division of Aging and Adult Services, for the establishment of two positions
to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult
Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the Department
of Health and Human Services, Division of Aging and Adult Services, to make annual reports to the
General Assembly on the status of the study.
Recommendation 6: Adult Care Home Residents
Recommendation 6a: Adult Care Home Admission Screening Process
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 8
mental health and developmental disability conditions as part of the adult care home admission
process. The process shall duplicate the nursing facility admission process and shall consist of an
automated screening tool and where indicated a face- to- face assessment by a mental health or
developmental disabilities professional. The Division of Medical Assistance shall report on the
design, development, and piloting of the screening process for mental health and developmental
disability conditions as part of the adult care home admission process on or before October 15,
2008.
Recommendation 6b: Transitional Residential Treatment Program Pilot Sites
The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084, for
2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental
Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically
diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.
Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care
Workers in Adult Care Homes
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Health Service Regulation, Division of Medical
Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse
Services to work with adult care home providers to build on recent studies to determine the most
appropriate and cost effective way to provide training on the care of individuals with mental illness
to direct care workers in adult care homes by tailoring the training to resident assessment results and
utilizing web- based formats as appropriate, and to provide an interim report to the Study
Commission on Aging by November 1, 2008, and a final report by November 1, 2009.
Recommendation 6d. Assessment and Service Plan Development for Adult Care Home
Residents
The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000, for
the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Medical
Assistance, to support assessment and service plan development for adult care home residents and
to provide an interim report by November 1, 2008, and a final report by November 1, 2009.
Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings
The Study Commission on Aging expresses support for the creation of a reward system for adult
care homes that achieve high ratings and at the appropriate time, the Commission anticipates
supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).
Recommendation 8: Support for Respite Care
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Aging and Adult Services, to study the adequacy of
service standards and funding for group respite services, and whether opportunities exist to
streamline and enhance the provision of respite services; direct the Division of Medical Assistance,
Department of Health and Human Services, to study the feasibility of providing respite care as a
State Plan Service, and provide a report on both issues to the Commission on Aging by November
1, 2009.
Recommendation 9: Study Older Adult Hearing Loss
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services to study the current and anticipated impact of hearing loss on North
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 9
Carolina's older adult population and the availability and access to qualified professionals for
treatment and hearing aid purchase assistance for low income individuals; to develop an inventory
of the technology available to assist individuals; and to evaluate resources and programs available
in other states, with a report to the Study Commission on Aging by November 1, 2008.
Recommendation 10: Criminal Background Checks for Nursing Home Administrators
The Study Commission on Aging recommends that the General Assembly enact legislation to give
the North Carolina Board of Nursing Home Administrators the authority to require a criminal
history record check for nursing home administrator license applicants.
Recommendation 11: Support Guardianship Study Recommendations
The Study Commission on Aging recommends that the General Assembly enact legislation to
authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in
determining drivers license revocation of an incompetent individual, and to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order, which are both based
on recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly.
Recommendation 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommends that the General Assembly enact House Bill 93,
Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to
study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines
for the installation and use of wheelchair tie- down systems, and to report findings and
recommendations to the Study Commission on Aging and the Joint Legislative Transportation
Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and
was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)
Recommendation 13: Study Medically Needy Income Standard
The Study Commission on Aging recommends that the General Assembly enact House Bill 92,
Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,
Division of Medical Assistance, to study the medically needy income standard and determine the
best method of increasing the standard while providing improved consistency across long- term care
settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate
Appropriations and was a recommendation to the 2007 General Assembly from the Study
Commission on Aging.)
Recommendation 14: Long Term Care Insurance Tax Credit
The Study Commission on Aging recommends that the General Assembly increase the Long- Term
Care Insurance Tax Credit to 75% of the premiums paid by the purchaser up to a maximum of
$ 1000.
Recommendation 15: Establish MAHS Registration Fee/ Penalty for Failing to Register
The Study Commission on Aging recommends that the General Assembly enact legislation to
require facilities meeting the definition of multiunit assisted housing with services ( MAHS) register
annually with the Division of Health Services Regulation, authorize the Division to charge a fee of
up to $ 350 per registration, and make it a Class 3 misdemeanor punishable only by fine for failing
to register.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 10
Recommendation 16: Special Assistance Income Disregard Study
The Study Commission on Aging recommends the Department of Health and Human Services,
Division of Aging and Adult Services, and Division of Medical Assistance, study whether North
Carolina can implement an income disregard policy for current Special Assistance and Medicaid
recipients who are adversely impacted due to cost of living or other income increases.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 11
Aging North Carolina:
The 2008 Profile
Prepared by the Department of Health and Human Services, Division of Aging and Adult Services
North Carolina’s Demographic Shift
North Carolina remains in the midst of a significant demographic change as the state’s 2.3 million
baby boomers ( those born between 1946 and 1964) are beginning to enter retirement age. Today,
the proportion of the state’s population who are seniors, ages 65 and older, is roughly 12 percent.
By 2030, when the youngest baby boomers are retirement age, the proportion should reach 17.7
percent, or 2.1 million older North Carolinians. The Baby Boomer Milestones table below shows
the milestones of the baby boomers expressed in terms of some major federal and state age- related
programs ( eligibility age in parenthesis). For example, last year ( 2006), the oldest boomers ( i. e.,
born in 1946) became eligible to receive services under the Older Americans Act, and as of January
of this year, some of the oldest boomers began receiving their first Social Security payments.
Table: Baby Boomer Milestones
Year when oldest boomers become eligible
Programs 2006 2007 2008 2009 2010 2011 2012
NC Senior Games participation ( 55)
Older Americans Act services ( 60)
Social Security at a reduced rate ( 62)
Medicare benefits ( 65)
Medicaid assistance for the Aged ( 65)
Full Social Security ( 66)
Figure A: Growth of Older North Carolinians Age 65+ ( 2000- 2030)
969,048 971,058
1,606,894
2,144,843
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2000 2010 2020 2030
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 12
Figure A indicates the projected growth of North Carolinians age 65+ from the year 2010 to the
year 2030. [ 1] The impact of the aging baby boomers is clearly indicated. As the graph shows, there
is little expected growth in the older population between 2000 and 2010. This is because the Great
Depression and World War II were times when the entire country experienced the lowest birth rates
the country had ever experienced up until that time. The small number of people born during those
two times ( 1929 to 1945) will be 65 to 81 years old in 2010. However, due to retirement migration
to North Carolina, we will not see an actual decline in the number of older adults in that period, as
some states will, but the growth will be modest.
Figure B shows the projected growth of the older population by county between 2000 and 2030.
During this period, growth for the state as a whole is projected at 50 percent, while the population
65 and older is expected to grow 121 percent, and the population 85 and older is expected to grow
144 percent. [ 1]
The eight counties with more than 200 percent growth can be divided into two very different
categories. Union, Wake, Johnston, and Hoke counties are experiencing rapid growth in their
overall population as expanding parts of metropolitan areas, and they will remain relatively “ young”
( the proportion of their population projected to be over 65 is lower than that of the state as a whole.)
The remaining four counties— Brunswick, Camden, Currituck, and Dare— by contrast, are projected
to see disproportionate growth in their aging population. Brunswick and Dare, in particular, are
projected to have substantially higher percentages of older adults ( 26.4 percent and 24.1 percent
respectively), compared to 17.7 percent for the state as a whole.
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Guilford Franklin
Harnett
Hoke
Johnston
Lee
Montgomery
Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
Greater than 200%
100 to 199% increase
43 to 99% increase
Figure B. Projected Growth of Population Ages 65 and Older from 2000 to 2030
Based on 2000 Census counts ( www. census. gov) and April 2030 projections ( 2006, Demographic Unit, Office
of State Budget and Management
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 13
Figure C. Percent of County Population Projected to Be Ages 65 and Older in 2030
Figure C shows the counties that will have the largest concentration of older adults in 2030. All are
in areas attractive to retirees, but many are also counties that will continue to lose younger residents
because of modest economic opportunities.
Although decreases in both fertility and mortality are the major factors in the aging of the state’s
population, migration also plays a key role. The following factors contribute to the different rates
of aging in the state’s 100 counties [ 2]:
 Rural- to- urban migration of young adults continues to age rural counties.
 Large metropolitan counties attract large numbers of persons from outside the state as well
as from rural counties.
 Large metropolitan counties are experiencing greater growth among younger adults than
they are among older adults.
 A large number of older adults with higher incomes are retiring in some western and coastal
counties, as well as other select counties with attractions to specific groups of older adults
( e. g., golf courses).
As shown in Figure D, North Carolina ranked third nationally as a retirement migration destination
with a net migration number of 34,290 among older adults ( 60+) in the five- year period between
1995 and 2000. Along with other Sunbelt states ( Florida, South Carolina, Texas, Tennessee,
Georgia, and Virginia), North Carolina remains a popular destination for people of all ages,
including seniors. [ 3] The latest data estimate is that 30,491 older adults ( 60+) relocated to North
Carolina from other states and abroad, in just one year, between 2005 and 2006 [ 4]. That means
that in 2006, two percent of people age 60 and older currently residing in North Carolina had been
living in another state the previous year.
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Guilford Franklin
Harnett
Hoke
Johnston
Lee
Montgomery
Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
More than 25% aged 65+
20 to 24.9% aged 65+
Less than 20% aged 65+
Note: The proportion in the state is 17.7%
Based on April 2030 projections ( 2006, Demographic Unit, Office of State Budget and Management
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 14
Figure D: Top Ten States with Net Number of Migrants Age 60+ ( 1995- 2000)
221,778
80,671
34,290 33,893 27,588 24,771 17,782 15,017 10,260 8383
0
50,000
100,000
150,000
200,000
250,000
FL AZ NC NV SC TX TN GA VA MO
States
Net Number of Migrants Age 60+
According to the most recent life tables from the North Carolina State Center for Health Statistics, if
age- specific mortality remains unchanged, babies born today in North Carolina are expected to live,
on average, to the age of 75.6 years. The North Carolinians who are age 60 today are expected to
live, on average, an additional 20.8 years to almost 81 years old. Generally, women live longer than
men and whites live longer than persons of other racial groups. However, at the oldest ages,
African Americans, in particular, have a life expectancy that is the same or slightly greater than that
of whites. This is known as the “ crossover effect.” [ 5]
Life Expectancies ( in Years) by Age Group, Gender, and Race
NC White All other Races*
Age Groups Combined Male Female Male Female
( At Birth) 75.6 73.8 79.6 68.0 75.8
60- 64 20.8 19.0 22.9 16.8 21.5
65- 69 17.1 15.4 18.9 13.8 17.8
70- 74 13.7 12.2 15.1 11.1 14.5
75- 79 10.6 9.3 11.6 8.8 11.4
80- 84 7.9 6.8 8.5 6.7 8.6
85+ 5.4 4.5 5.7 4.8 6.0
* This group is primarily African American, but other much smaller racial groups including Asian and
American Indian, are included. Source: NC Center for Health Statistics ( 2002). Healthy Life Expectancy in
North Carolina, 1996- 2000
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 15
What Are the Implications of this Shift?
The aging of the population is a national and international trend, and North Carolina, like the rest of
the world, must be prepared to reap the benefits and face the challenges of an older population.
Government faces decisions about the allocation of public resources from a tax base that may
experience slowed growth, especially in many aging rural counties. People must consider living
and caregiving arrangements in light of smaller nuclear and extended families. The health, human
service, employment, and education systems must adapt to the changing needs and interests of the
seniors of today and tomorrow. The business and faith communities as well as others must identify
and respond to the challenges and opportunities of these demographic shifts.
In the 2003- 2007 State Aging Services Plan, the Division of Aging and Adult Services, Department
of Health and Human Services, introduced a new initiative– Livable and Senior- Friendly
Communities– to raise awareness of the aging of our population. The initiative was also designed to
encourage North Carolina’s communities to become more senior- friendly, and livable for all people,
through collaboration among citizens, agencies, organizations, and programs, in both the public and
private arenas. This initiative formed the core around which the 2007– 2011 State Aging Services
Plan was organized. A livable and senior- friendly community in North Carolina will draw on the
talents and resources of active seniors while enhancing services for those who are vulnerable
because of their health, economic hardships, social isolation, or other conditions. A livable and
senior- friendly community will work to address a wide range of issues and concerns ( e. g., air
quality, housing, long- term care services, employment, enrichment opportunities) that, as a whole,
affect the quality of life of seniors and others in the community. Also, a livable and senior- friendly
community will assure good stewardship of its resources to meet the needs of today’s seniors, while
helping baby boomers and younger generations prepare for the future.
Demographic Highlights
Population
North Carolina ranks tenth among states in the number of persons age 65 and older and tenth in the
size of the entire population. [ 6] The fast pace of growth of the state’s older population is evident in
a US Census Bureau’s release in which North Carolina was ranked fourth nationally in the increase
of the number of older persons age 65+ ( 47,198 in NC) between April 2000 and July 2003. Only
three other states ( California, Texas, and Florida) reported a greater increase among their older
populations. Even so, when combined with the equally strong growth in other age groups, North
Carolina continues to maintain an overall healthy demographic balance among the generations, as it
is thirty- eighth among states in the proportion of the population over 65. [ 7]
 Estimated NC population age 65+ in 2006: 1,059,551 ( 12.0 percent of total population)
 Estimated NC population age 85+ in 2006: 132,412 ( 1.5 percent of the total population)
Diversity and Disparity
North Carolina is rich in diversity, but its citizens face challenges because of the disparity that exists
among all populations, including older adults. Some important differences among NC’s older
adults relate to gender, marital status, ethnicity/ race, residence, rurality, disability, health status,
grandparents raising grandchildren, and veteran status.
 Gender: Older women represent 59.8 percent of the 65+ age group and 72.4 percent of the 85+
age group. [ 8] The higher rate of poverty among older women remains a primary issue today.
For example, women age 75+ are twice as likely to be poor as men the same age. [ 9]
 Marital Status: Because men have shorter life expectancy, and because they tend to marry
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 16
younger women, at ages 65 and older, women are more than twice as likely to be unmarried as
men in their age group. [ 10] Data show that being unmarried ( widowed, divorced, separated,
or never married) increases a woman’s vulnerability to poverty. According to the Social
Security Administration, in 2005, 89% of married couples and 88% of nonmarried persons
aged 65 or older received Social Security benefits. Social Security was the major source of
income ( providing at least 50% of total income) for 54% of aged beneficiary couples and 72%
of aged nonmarried beneficiaries. It was 90% or more of income for 22% of aged beneficiary
couples and 42% of aged nonmarried beneficiaries. [ 11]
Percent of Unmarried Individuals by Age Group
Age 65- 74 Age 75- 84 Age 85+
Unmarried Women in NC 45.0 65.0 89.6
Unmarried Men in NC 20.9 26.0 41.4
Source: American Community Survey ( 2006). Table B12002.
 Ethnicity/ Race: Altogether 18.7 percent of persons age 65+ are members of ethnic minority
groups in North Carolina. [ 12] Compared to the nation as a whole, North Carolina’s
population age 65+ includes a larger proportion who are African American ( 15.6 percent in NC
compared to 8.3 percent nationally) and a smaller proportion of Latinos ( 1.2 percent in NC
compared to 6.4 percent nationally). American Indians, Asian Americans, and other ethnic
groups account for 2.0 percent of the age group 65 and older. In North Carolina, as well as
nationally, older adults from most ethnic minority groups show both a higher poverty rate and
a lower life expectancy when compared with the non- Latino white population. Poverty rates
for the two largest racial groups are shown in the table below. [ Note: See the Demographic
Shift section for the information on life expectancy.]
Percent Below Poverty Level for the Older Population of North Carolina
by Gender, Race, and Age Group
White African American
Male Female Male Female
Age Group 65 - 74 5.0 8.5 17.6 23.5
Age Group 75+ 6.5 12.6 21.9 35.0
Data from 2006 American Community Survey reflecting poverty in 2005.
 Residence: The 2000 Census showed that in North Carolina, 81.4 percent of householders age
65 and older owned their homes ( with or without mortgage), yet among homeowners in that
age group, over 61,000 reported incomes for 1999 that were below poverty. This figure
means that 11.8 percent of the homeowners over age 65 were poor, compared to 7.5 percent
for homeowners of all age groups. [ 13] This has implications for both helping some older
adults be responsible for their own needs ( e. g., reverse mortgages) and for the need for
property tax relief to older adults. Among renters age 65+ who provided information, 63.2
percent, or 72,739 households, spent more than 30 percent of their household income on rent
[ 14]. Furthermore, 5,000 North Carolina homeowners and renters age 65+ lacked complete
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 17
plumbing facilities in their homes. [ 15]
 Rurality: Among all age groups, 39.8 percent of North Carolina residents live in rural areas
compared to only 21.0 percent for the country as a whole. [ 16] The percentage among older
adults is no doubt higher ( based on the percentages of older adults in the predominantly rural
counties), but there is no age- specific figure available. In 2000, North Carolina's rural
population ( 3,202,238) was almost as large as the one in Texas ( 3,647,747), the state with the
largest number of rural residents in the nation. Not only was North Carolina's rural population
among the largest in terms of numbers, but the state also reported the highest proportion ( 39.8
percent) of rural population among the 20 most populous states in the nation. While 11 other
states reported higher proportions of rural population, ranging from 40.7 percent to 61.8
percent, all of these states are much smaller in total population than North Carolina. Thus,
North Carolina is unique among more populous states in having so large a rural contingency.
At the same time North Carolina has made the transition away from an agricultural economy
so that only 1.1 percent of its people live on farms, only slightly more than the 1.0 percent for
the nation as a whole. A 2002 report from Making a Difference in Communities ( MDC)
highlights a long list of challenges that rural residents and their communities face— isolation
by distance, lagging infrastructure, sparse resources that cannot adequately support education
and other public services, and weak economic competitiveness. [ 17]
 Disability: In North Carolina, 42.0 percent of the non- institutionalized civilian population ages
65 and older reported having one or more disabilities by the US Census definition— 45.5
percent of women and 40.7 percent of men, according to the 2006 American Community
Survey. [ 18] The Census Bureau defines disability as “ a long- lasting physical, mental, or
emotional condition that makes it difficult for a person to do activities such as walking,
climbing stairs, dressing, bathing, learning, or remembering. This condition can also impede a
person from being able to go outside the home alone or to work at a job or business.” This
definition is very broad and leads to counting a number of people who, indeed, have
difficulties but are able to function independently and would not meet the average person’s
perception of a person with a disability.
 Health Status: Heart disease is the leading cause of death among older adults both nationwide
and in North Carolina with cancer and stroke, second and third on the list. [ 19] In particular,
the coastal plain region of North Carolina has the fourth highest stroke death rate in the nation
and is labeled by some as the Buckle of the Stroke Belt [ 20]. African Americans and other
racial minorities are at substantially higher risk for certain chronic conditions such as heart
disease, stroke, and diabetes ( a major contributor to heart disease, stroke, and other
conditions). [ 5] Diabetes mellitus is the sixth leading cause of death for the older North
Carolina population in general, but like stroke, it is a more serious threat to the African-
American community, being the fourth highest cause of death in African Americans of all
ages in our state [ 19].
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 18
Five Leading Causes of Death among North Carolinians Age 65+
Rank Cause
1 Heart diseases
2 Cancer
3 Cerebrovascular diseases including stroke
4 Chronic lower respiratory diseases
5 Alzheimer’s disease
Source: NC Center for Health Statistics ( 2006). Leading Causes of
Death – 2005.
An important factor in health status is physical activity. A sedentary lifestyle is known to
increase a person’s risk of heart disease, diabetes, and other chronic conditions.
Unfortunately, in a multi- year study, North Carolinians age 65+ were ranked 48th among the
50 states in physical activity with nearly 40 percent of residents aged 65 and older reporting
that they did not engage in any physical activity in the past month. [ 21] The 2005 Behavioral
Risk Factor Surveillance System ( BRFSS) shows that nearly 66 percent of adults in that age
group do not participate in recommended levels of physical activity [ 22]. The BRFSS also
shows over one- third of people age 65+ say that their general health status is fair or poor.
 Grandparents Raising Grandchildren: According to the 2006 American Community there were
85,358 NC grandparents who reported that they had one or more grandchildren living with
them for whom they are responsible. This represents nearly half of all grandparents whose
grandchildren live with them and 1.6 percent of all North Carolina grandparents. Among
those grandparents responsible for their grandchildren, over 49 percent live in households in
which neither parent of the child is present. [ 23] According to AARP, 47 percent of NC
grandparents responsible for their grandchildren are African American; 2 percent are
Hispanic/ Latino; 2 percent are American Indian or Alaskan Native; and 47 percent are white
[ 24]. Given the relative sizes of these populations, it is clear that this is an even larger issue in
the African- American community than among other ethnic groups.[ 24]
 Veteran Status: Of the estimated 773,861 veterans living in North Carolina in 2007, over
263,755, or 34 percent, were age 65 and older. Another 260,811 ( 33 percent) were age 50 to
65, most of whom were Vietnam- era veterans. [ 25] The group of veterans from the Vietnam-era
contains proportionally more disabled members than survivors of earlier wars due to
quicker and more advanced medical treatment. [ 26] The Veterans Administration has
frequently written about the aging of the veterans as a major challenge to its health care
system in coming years.
Summary
In summary, North Carolina has a large, economically and ethnically diverse older population.
With this diversity come both special assets and special challenges. Even the most vulnerable older
adults often give as much to their communities as they receive. Nevertheless, we must be aware that
those who face disabilities, disparities of income and health care, and the responsibilities of caring
for grandchildren are more likely to need public services and supports. While meeting these
disparate needs of today’s older adults, our state is also witnessing the first minor steps of the
transition of the baby boomers into retirement ages. This will transform the age structure of the
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 19
state and bring a new generation of older adults with some of the same historic issues, but also new
attitudes, new challenges, new opportunities, and new resources.
Sources of Information
[ 1] Demographic Unit, Office of State Budget and Management ( 2006). " County Projected Age Groups: April 2010,
April 2020, and April 2030.
[ 2 ] NC Division of Aging and Adult Services ( 2003). The Aging of North Carolina: The 2003- 2007 North Carolina
Aging Services Plan
[ 3] Charles Longino ( 2003). States Ranked by the Net Number of Migrants Age 60+, 1985- 1990 and 1995- 2000.
[ 4] US Census Bureau ( 2008). 2006 American Community Survey Table B07001.
[ 5] NC Center for Health Statistics ( 2002). Healthy Life Expectancy in North Carolina, 1996- 2000.
[ 6] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File
stterr2006. xls: 2006- 50+ rank#”
[ 7] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File
stterr2006. xls: 2006- 50+ rank%”
[ 8] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ files
stterr2006. xls: 2006- 50+ x5,“ “ stterr2005. xls: 2006- 50+ x5- M” and “ stterr2006. xls: 2006- 50+ x5- F”
[ 9] Institute for Research on Women & Gender ( 2002). Difficult Dialogues Program Consensus Report: Aging in
the Twenty- first Century.
[ 10] US Census Bureau ( 2008). 2006 American Community Survey. Table B12002.
[ 11] US Social Security Administration ( 2008). Fast Facts & Figures about Social Security.
[ 12] US Administration on Aging ( 2008). Number of Persons 65+ by Race and Hispanic Origin- by State- 2006. File:
stterr2006. xls: 65+% xRace- HO
[ 13] US Census Bureau ( 2003). Census 2000 Summary File 3. Tables HCT2 and HCT24
[ 14] US Census Bureau ( 2003). Census 2000 Summary File 3. Table H71
[ 15] NC State Library ( 2003). Special tabulation from the Census 2000 data as requested by the NC Division of
Aging and Adult Services.
[ 16] US Census Bureau ( 2003). Census 2000 P5 ( Summary File 3).
[ 17] Making a Difference in Communities in the Sought ( MDC) ( 2002). State of the South 2002.
[ 18] US Census Bureau ( 2008). 2006 American Community Survey. Table B18001.
[ 19] NC Center for Health Statistics ( 2008). Leading Causes of Death- 2006
http:// www. schs. state. nc. us/ SCHS/ deaths/ lcd/ 2006/ pdf/ TblsA- F. pdf.
[ 20] Tri- State Stroke Network. ( 2006) Facts and Statistics: Stroke in the United States
http:// www. tristatestrokenetwork. org/ facts. html# buckle
[ 21] NGA Center for Best Practices ( 2004). Measuring the Years: State Aging Trends & Indicators.
[ 22] NC Department of Health and Human Services ( 2006). Behavioral Risk Factor Surveillance Calendar Year 2005
Results.
[ 23] US Census Bureau ( 2008). 2006 American Community Survey. Table B10050.
[ 24] AARP ( 2006). A State Fact Sheet for Grandparents and Other Relatives Raising Children.
[ 25] US Department of Veterans’ Affairs VetPop2006 Version 1.0 State and National Tables ( yearly projections)
http:// www1. va. gov/ vetdata/ docs/ 1l. xls
[ 26] US Department of Veterans’ Affairs ( 2002) VA History in Brief http:// webpages. charter. net/ wisconsinlegion-
7thdistrict/ VA_ History. htm# Vietnam_ War
Web Sites for Related Information
 NC Division of Aging and Adult Services ( http:// www. dhhs. state. nc. us/ aging/ demo. htm)
 Demographics Unit, NC Office of Budget and Management ( http:// demog. state. nc. us/)
 NC State Center for Health Statistics ( http:// www. schs. state. nc. us/ SCHS/)
 US Census Bureau ( http:// www. census. gov)
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 20
COMMISSION PROCEEDINGS
January 24, 2008
The North Carolina Study Commission on Aging met on Thursday, January 24, 2008, at 10: 00 a. m..
in Room 643 of the Legislative Office Building. Senator Vernon Malone presided. Following
introductions, Theresa Matula, Commission staff, presented an overview of the Commission's
responsibilities and statutory authority, the tentative meeting schedule for the interim, and the
Commission's budget. The Commission approved the budget.
Next the Commission heard from Shawn Parker, Commission staff, who presented a status report of
the Study Commission on Aging's recommendations to the Governor and the 2007 General
Assembly. A copy of the 2007 Recommendation Status Report is included in Appendix A. Ben
Popkin, Commission staff, then presented a document containing summaries of substantive
legislation related to older adults that was enacted during the 2007 Session. The Summary of
Substantive Legislation Related to Aging is included in Appendix A. Mr. Popkin was followed by
Melanie Bush of the Fiscal Research Division who provided an overview of 2007- 2009 legislative
budget actions and special provisions which are also provided in Appendix A.
The next presentation was an overview of older adults in North Carolina provided by Ms. Matula.
Her presentation focused on: who they are, how many there are, where they live, and what types of
programs and services are available for older adults in North Carolina. The presentation included
data on changes in the North Carolina population which depict the probability of significant growth
in the older adult population. The presentation included a brief summary of the range of services
provided in the State which include: Senior Games, Senior Centers, Adult Day Care and Adult Day
Health Care, State/ County Special Assistance, the State/ County Special Assistance In- Home
Program, the services provided by Home and Community Care Block Grant funds, the Community
Alternatives Program for Disabled Adults ( CAP/ DA), assisted living, Multiunit Assisted Housing
with Services, Adult Care Homes, Nursing Homes, and Continuing Care Retirement Communities.
Ms. Matula ended her presentation by mentioning additional information and resources including
the Area Agencies on Aging and various divisions within the Department of Health and Human
Services that serve older adults.
The last presentation for this meeting was a report required by S. L. 2007- 355, Section 2. In
response to the growth projections for the age 60+ population, the Division of Aging and Adult
Services, Department of Health and Human Services, was required to make recommendations on a
study to include all counties in North Carolina. The legislation required that the recommendation
specify the criteria that should be included in a study and an appropriate funding level for such a
study. Dennis Streets, Director, Division of Aging and Adult Services, reported that of the states
surveyed, 15 states indicated that they had undertaken a comprehensive statewide study in the past
five years. The reported costs ranged from $ 20,000 to $ 500,000 for the survey, but the states
emphasized that the important work does not end in a study. In fact, the study is just the beginning.
In response to these findings, the Division recommended the following: the State create a strategic
steering team; assess consumer needs, assets, and expectations; assess State and local awareness and
preparedness; conduct special studies; support State and local planning; and create an aging data
warehouse. The Division estimated a cost of $ 175,000 for the establishment of two positions to
support the work of the study, and $ 3,820,000 to fund the first year of the study. Of the $ 3,820,000,
$ 1,470,000 would be used to strengthen the capacity of Area Agencies on Aging ( AAA) for support
of regional and local planning ( including $ 270,000 to restore AAA State support reduced in 2001,
and $ 1,200,000 to add a position at each AAA to facilitate regional and community planning for
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 21
aging). The remaining $ 2,000,000 would provide $ 20,000 to each county to aid the work of citizen-driven
local aging leadership planning teams.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 1- 24- 08 Meeting.)
February 28, 2008
The North Carolina Study Commission on Aging met on February 28, 2008, at 1: 00 p. m. in Room
544 of the Legislative Office Building. Representative Jean Farmer- Butterfield was the presiding
Co- Chair.
During this meeting, the Commission heard brief presentations from 21 associations and
organizations that represent older adults. Each organization presented their legislative priorities and
or issues of concern to the Commission. For summary purposes, the issues mentioned with the
greatest frequency were: Increase Home and Community Care Block Grant Funds, Increase Senior
Center Funds, Provide Funding for Project C. A. R. E., Support for Adult Protective Services/ Enact
and Fund the Adult Protective Services Clearinghouse Model Pilot, and Increase Funds for New and
Existing Special Care Dental Programs ( Care in Underserved Areas, Long- term Care, Disabled
Seniors at Home). A Summary of Issues Most Frequently Mentioned by Organizations
Representing Older Adults is located in Appendix B.
The Commission also heard a report on Project C. A. R. E. ( Caregiver Alternatives to Running on
Empty). Steve Freedman, Service Operations Section Chief, Division of Aging and Adult Services,
Department of Health and Human Services; Dr. Charles Dickens, Speaker, Senior Tar Heel
Legislature; and Lisa Gwyther, Family Support Program Director, Duke Center for the Study of
Aging and Human Development; provided information about Project C. A. R. E. The goal of Project
C. A. R. E is to increase quality, access, choice, and use of respite and support services to low- income
rural and minority families caring for a person with dementia at home or within a hospital setting.
The program currently has three pilot sites that serve 14 counties and is administered through the
Division of Aging and Adult Services. The Division receives consultation and technical assistance
from the Duke Aging Center Family Support Program and is currently based within the
Mecklenburg County Department of Social Services, and two area offices of the Western Carolina
Alzheimer's Chapter. Project C. A. R. E. has received national recognition by numerous
organizations as a best practice model. Funding thus far has been provided by the U. S.
Administration on Aging's Alzheimer's Disease Demonstration Grants, leveraged through grants
provided by private foundations, and supplemented by Family Caregiver Support Programs.
However, grant funding is no longer an option for this particular program and State funding is
needed to continue the program. It was reported that the Department of Health and Human Services,
Division of Aging and Adult Services, would need $ 500,000 to sustain Project C. A. R. E. activities
in 14 western and piedmont counties.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 2- 28- 08 Meeting.)
March 6, 2008
The North Carolina Study Commission on Aging conducted the first of two public hearings this
interim on March 6, 2008, at 10: 00 a. m. in the Upper Coastal Plain business Development Center,
Wilson, North Carolina. Representative Jean Farmer- Butterfield was the presiding Co- Chair. At
this hearing, forty- two ( 42) people spoke to Commission members about a number of concerns
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 22
including: Increase Funding/ Continue Support for Senior Centers, Increase/ Continue Support for
Senior Games, Increase/ Continue Funding for Alzheimer's and Project C. A. R. E., Increase Funding
for Home and Community Care Block Grant ( HCCBG), Resolve Issues Related to Mentally Ill in
Long- Term Care Facilities, Increase Funding/ Support for Senior Friendly Housing. Appendix C
contains a summary of the public hearing comments.
March 28, 2008
The North Carolina Study Commission on Aging met on Friday, March 28, 2008, at 10: 00 a. m. in
Room 544 of the Legislative Office Building. Senator Vernon Malone was the presiding Co- Chair.
At this meeting, the Commission received a summary of the issues most frequently mentioned
during organization presentations and public hearings; heard a presentation from Dr. Victor
Marshall, Director, UNC Institute on Aging; and received reports on Respite Care, Mentally Ill in
Adult Care Homes, and a Reward System for Adult Care Homes with High Ratings.
Theresa Matula, Commission staff, presented summaries of the issues most frequently mentioned
on February 28, 2008, by organizations representing older adults, and a summary of the issues most
frequently mentioned during the public hearing on March 6, 2008. These summaries are located in
Appendix B and Appendix C.
Next, Victor Marshall, Director, UNC Institute on Aging, provided the Commission with
information about UNC Institute on Aging and the projects and programs that it supports. Dr.
Marshall also expressed: recommendations for a statewide aging study; the importance of
addressing public health issues of older adults; support for the Win A Step Up program; and
concerns related to aging workforce initiatives, specifically mentioning the Forum on North
Carolina's Aging Workforce, a two- day conference scheduled for September 23- 24, 2008.
In response to S. L. 2007- 39, Larry Nason, Chief, Facility and Community Care Section, Division of
Medical Assistance, Department of Health and Human Services ( DHHS), provided a report on
respite care. The report included information on the availability of respite care in North Carolina,
respite care in other states, and outlined four model programs. The respite care study group made
the following findings: separate statutory language for respite care is not needed; the existing
licensure and certification systems used by the Division of Health Service Regulation and the
Division of Aging and Adult Services allow for appropriate regulation of all levels and types of
respite care; consistent and predictable State funding for current respite care models is needed;
currently NC Medicaid only provides respite care as a billable service under its waiver programs
and as such, respite care is not provided as a " regular Medicaid" benefit under the State Plan. The
study group recommended that the North Carolina General Assembly provide an appropriation for
Project C. A. R. E., increase the State Adult Day Care Fund, and expand the Aging and Disability
Resource Connections to increase information and access on respite care services. The study group
also recommended that the Division of Aging and Adult Services study the place of group respite
programs in the long- term care continuum and assess the adequacy of service standards and
funding, and that the Division of Medical Assistance continue to study the potential of respite as a
State Plan Service.
S. L. 2007- 156 required the Department of Health and Human Services to study rules and
regulations regarding housing individuals with mental illness in the same facility vicinity as
individuals without mental illness, and to recommend staff training requirements for direct care
workers in adult care homes to provide appropriate care to residents with mental illness. Jackie
Sheppard, Assistant Secretary, Long Term Care and Family Services, DHHS, and Bonnie Morrell,
Best Practice & Community Innovations Team Leader, Division of Mental Health, Developmental
Disabilities and Substance Abuse Services, DHHS presented the report. The report includes: an
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 23
overview of how eight other states handle placement of mentally ill individuals in assisted
living/ adult care home facilities; information on the limited use of adult care home special care units
for residents with mental health disorders; revisions to staffing rules; recommendations and cost
figures on the screening, assessment, and the provision of services to mentally ill individuals in
adult care homes; and proposed training recommendations and associated costs.
The report recommended six items at a cost of $ 20.9 million dollars in recurring funds and
approximately $ 1.8 million in nonrecurring funds. The recommended system includes: developing
and automating a comprehensive assessment and care plan system for residents in adult care homes;
expanding required minimum training levels; requiring Preadmission Screening and Annual
Resident Review ( PASARR) Level II assessments of adult care home residents or potential
residents who are referred for this level of evaluation; determination of specialized mental health
care needs based on PASARR Level II assessments; development of additional capacity to serve
residents in adult care homes who need mental health services; and the implementation of a pilot to
develop a residential program for people with mental illness currently in adult care homes but who
require a different residential setting. The report included a flow chart depicting the steps for an
individual with a history of mental illness. The first step included screening adult care home
residents using the Medicaid Uniform Screening Tool ( MUST) which would identify the need for a
face to face mental health evaluation. If the mental health assessment was needed, a professional
assessment would be given using PASARR Level II. For those individuals that need specialized
mental health services, care would be provided either in a mental health residential setting, or the
person would live in the adult care home and mental health care would be provided by community
mental health services. The key to implementation of most, if not all, of these changes seem to
hinge on screening and assessment of adult care home residents to determine individual needs.
The final report for this meeting presented by Jeff Horton, Chief Operating Officer, Division of
Health Service Regulation, DHHS, was on a reward system for adult care homes with high ratings.
The report, developed pursuant to S. L. 2007- 544, Section 3d., recommended a system modeled after
a nursing home program that has been successful in making facilities better places for residents to
live and better places for employees to work. The report recommends that adult care homes
achieving a four star rating ( 100 points or higher on two consecutive annual surveys by the Division
of Health Service Regulation), under the Star Rating System, are deemed to have received a high
rating and are therefore eligible for the reward.
The nursing home program is funded with civil monetary penalties. However, under North
Carolina law, fines collected from adult care homes are transferred to local education agencies. As
such the General Assembly would have to appropriate funds for the reward system for adult care
homes. The Star Rating System is effective January 2009, thus January 2010 would be the first time
facilities might be eligible for rewards, assuming a score of 100 points during the 2009 cycle and
during the 2010 cycle.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 3- 28- 08 Meeting.)
April 10, 2008
The North Carolina Study Commission on Aging met at 10: 00 a. m. on April 10, 2008, in Room 421
of the Legislative Office Building. Representative Jean Farmer- Butterfield presided. Presentation
topics included: criminal background checks for nursing home administrators, guardianship issues,
hearing challenges for older adults, and a report on the aging service levels and needs study.
Jane Baker, Executive Director, North Carolina State Board of Examiners for Nursing Home
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 24
Administrators, and Steve Fleming, Chair, North Carolina State Board of Examiners for Nursing
Home Administrators, presented information on a statutory amendment that would grant the Board
the authority to conduct criminal history record checks. Information presented to the Commission
indicated that the Board desires the authority to require criminal history record checks on:
applicants from North Carolina, applicants seeking licensure by reciprocity, and persons renewing
their licenses.
Pamela W. Best, Deputy Legal Counsel, Administrative Office of the Courts, gave the Commission
an overview of guardianship in North Carolina. Her presentation focused on the determination of
incompetency, the appointment of a guardian, and the powers and responsibilities of guardians.
Representative Melanie Goodwin followed the presentation with information on two
recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly. The Study Committee on State Guardianship Laws found that guardians
currently have the authority to sell up to $ 1,500 worth of personal property without a court order in
order to meet the monetary needs of the ward, but determined that this amount was outdated and
insufficient, and recommended that the total amount of personal property allowed to be sold without
a court order be increased to $ 15,000. In response to the findings, House Bill 794 was introduced
but did not crossover to the Senate and is not eligible for consideration during the 2008 Session.
During the course of their work, the Committee on State Guardianship Laws also found it
unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an
individual who has been declared incompetent. In response, the Committee recommended that the
Division of Motor Vehicles be authorized to not automatically revoke the drivers license of an
incompetent if the clerk of superior court recommends the incompetent be allowed to retain the
drivers license. House Bill 796 was introduced during the 2007 Session, but did not crossover to the
Senate and is not eligible for consideration during the 2008 Session.
Dennis Streets, Director, Division of Aging and Adult Services, Department of Health and Human
Services presented a report in response to S. L. 2007- 355, Section 1. The law directed the Division
of Aging and Adult Services, to work with the Division of Health Service Regulation; Division of
Medical Assistance; Division of Public Health; and the Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services; to study programs and services for older adults in
Brunswick, Buncombe, Gaston, Henderson, Moore, and New Hanover Counties which currently
have, or are projected by 2030 to have, the largest numbers of individuals age 60+ when compared
to individuals age 17 and younger. In conducting the study, the Division was directed to utilize
existing data and resources, to include the Area Agencies on Aging serving each county studied,
and to report to the Study Commission on Aging and to the board of county commissioners of each
county studied. The study included the following elements: a profile of the current older adult
population; a profile of the projected growth for the older adult population; an assessment of the
anticipated impact on programs and services that address the needs of the older adult population;
identification of programs and services that are currently in place; identification of programs and
services that are needed to meet the growth projections; current funding sources for programs and
services serving the older adult population; anticipated funding needs for programs and services
serving the older adult population; and a delineation of the programs and services that are shared or
offered jointly with another county. Mr. Streets outlined the approach taken, the products provided
to each of the six counties, and highlighted particular findings for the Commission. The
presentation also listed the top areas of concern identified by the survey.
Next, Theresa Matula, Commission staff, presented draft recommendations for the Commission's
consideration. The draft recommendations represented a range of programs and issues heard by the
Commission during the interim. Ms. Matula presented 13 recommendations with background
information for each and explained that once the Commission approved recommendations, they
would be compiled in a report, including bill drafts as applicable, for the Governor and the 2008
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 25
General Assembly. During this meeting, the Commission approved 13 recommendations contained
in this report and agreed to consider several additional recommendations presented by a
Commission member at the final meeting on May 12, 2008.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 4- 10- 08 Meeting.)
April 24, 2008
The North Carolina Study Commission on Aging conducted a second public hearing this interim at
10: 00 a. m. on April 24, 2008 at the Town Hall in Jamestown, North Carolina. The Commission
heard from fifty- two ( 52) individuals during this hearing. The issues mentioned with greatest
frequency during the Jamestown hearing were: Funding for Project C. A. R. E., Continued Support
for the Star Rating System, Support for the Adult Protective Services Pilot Program, Increased
Funding for the Home and Community Care Block Grant ( HCCBG), Support for Access Dental
Care and Mobile Dental Units, Support for Adult Day Care, and Support for Senior Centers.
Appendix C contains a summary of the public hearings and information on which topics were
mentioned most frequently at both hearings.
May 12, 2008
The North Carolina Study Commission on Aging met on May 12, 2008, at 10: 00 a. m. in Room 544
of the Legislative Office Building. Senator Malone was the presiding Co- Chair. During the
meeting, staff reviewed the Commission's draft report to the Governor and the 2008 Regular
Session of the 2007 General Assembly. The Commission voted to approve the draft report as
amended.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 26
COMMISSION RECOMMENDATIONS
The North Carolina Study Commission on Aging makes the recommendations presented in this
report to the Governor and the 2008 Session of the 2007 General Assembly. Each recommendation
is followed by background information, and corresponding legislative proposals, if applicable,
appear Appendix D of this report.
Recommendation 1: Senior Center Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent
that it shall become part of the continuation budget.
Background 1: Senior Center Funds
During 2007, the Study Commission on Aging recommended that the General Assembly
appropriate an additional $ 500,000 for the 2007- 2008 fiscal year ( FY) and $ 500,000 for the 2008-
2009 FY, to the Senior Center General Purpose Fund to provide additional support for Senior
Centers. The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)
contained $ 200,000 in non- recurring funding for the 2007- 2008 FY for the Senior Center General
Purpose Fund.
Increasing senior center funds generally, or specifically making the 2007- 2008 FY increase
recurring, were the most frequently mentioned items during the Wilson public hearing on March 6,
2008 and was mentioned often during the public hearing in Jamestown. Increasing senior center
funding was the second most frequently mentioned item during the February 28, presentations to
the Commission by organizations representing older adults. It was listed as a priority by the
Governor's Advisory Council on Aging, and the Senior Tar Heel Legislature, among others.
Services offered through senior centers include: health and wellness programs, arts and humanities,
intergenerational programs, employment assistance, transportation services, and volunteer
opportunities. The National Institute of Senior Centers defines a senior center as a, " place where
older adults come together for services and activities that reflect their experience and skills,
respond to their diverse needs and interests, enhance their dignity, support their independence, and
encourage their involvement in and with the center and the community."
The Division of Aging and Adult Services reports that there are currently 164 recognized senior
centers in North Carolina. Primary sources of funding are: 1) the Home and Community Care
Block Grant, 2) local government, and 3) the State's Senior Center General Purpose and Outreach
Funds.
The State supports senior centers by funding the Senior Center Outreach and General Purpose
funds. The Senior Center General Purpose Fund was initiated in 1997 and is used for any purpose
that supports operations or development including: equipment purchases/ repairs, building
maintenance, supplies, administrative costs, activities, and construction.
The State appropriation for the 2007- 2008 FY is $ 1,465,316 for the Senior Center General Purpose
Fund and $ 100,000 for Senior Center Outreach. An additional 25% local cash or in- kind match is
required for receipt of State funds. For FY 2007- 08, Senior Centers received a $ 200,000 increase
in General Purpose funds on a non- recurring basis.
Senior Centers receive funding in " shares" – one share for Uncertified Centers ( 108 centers), two
shares for Centers of Merit ( 8 centers), and three shares for Centers of Excellence ( 48 centers). The
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 27
State allocation distribution for the 2007- 2008 FY is: $ 5,467 for Uncertified Centers, $ 10,936 for
Centers of Merit, and $ 16,404 for Centers of Excellence.
The Study Commission on Aging recognizes the importance of senior centers and supports
enactment of 2007- SHz- 23 to provide additional funding for the 2008- 2009 fiscal year.
Recommendation 2: Additional HCCBG Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 2,500,000, to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the
Home and Community Care Block Grant ( HCCBG).
Background 2: Additional HCCBG Funds
Increasing Home and Community Care Block Grant ( HCCBG) Funds was the issue mentioned
most frequently during the February 28, presentations to the Commission by organizations
representing older adults, the second most frequently mentioned item at the public hearing in
Wilson and one of the most frequently mentioned items at the Jamestown public hearing. Eight of
the 21 organizations that spoke on February 28, supported increasing HCCBG Funds including the
Governor's Advisory Council on Aging and the Senior Tar Heel Legislature.
In 2007, the Study Commission on Aging recommended the General Assembly appropriate an
additional $ 5,000,000 to the Department of Health and Human Services for the 2007- 2008 fiscal
year and $ 5,000,000 for the 2008- 2009 fiscal year for the Home and Community Care Block Grant
( HCCBG). The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)
contained $ 536,000 in recurring funding for the 2007- 2008 fiscal year and the 2008- 2009 fiscal
year.
The HCCBG, established by G. S. 143B- 181.1( a)( 11), is the consolidation of several funding
sources ( i. e., the Older Americans Act, the Social Services Block Grant in support of respite care,
portions of the State In- Home and Adult Day Care funds, and other relevant State appropriations).
The HCCBG includes federal funds, State funds, local funds, and a consumer contribution
component. It gives counties discretion, flexibility, and authority in determining services, service
levels, and service providers, and streamlines and simplifies the administration of services.
With input from older adults, county commissioners approve an annual funding plan that defines
the services to be provided, the funding levels for these services, and the community service
agencies to provide the services. Counties can select from among 18 eligible services including:
Adult Day Care, Adult Day Health Care, Care Management, Congregate Nutrition, Group Respite,
Health Promotion and Disease Prevention, Health Screening, Home Delivered Meals, Housing and
Home Improvement, Information and Assistance, In- Home Aide, Institutional Respite Care, Mental
Health Counseling, Senior Center Operations, Senior Companion, Skilled Home ( Health) Care,
Transportation, and Volunteer Program Development. Counties decide which services to provide,
however congregate nutrition and home- delivered meals are provided in almost every county under
the HCCBG.
Any person age 60 and older is eligible for services under the HCCBG. Although, the HCCBG
program places an emphasis on reaching those most in need of services. The Older Americans Act
( OAA), a funding source in the HCCBG, gives priority to serving the " socially and economically
needy" and focuses particular attention on the low income minority elderly and on older individuals
residing in rural areas. Additionally, the OAA calls for reaching out to older individuals with severe
disabilities, limited English- speaking ability, and Alzheimer's disease or related disorders and
caregivers of these individuals.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 28
The focus of the HCCBG is to support the frail elderly that are cared for at home; improve and
maintain the physical and mental health of older adults; assist older adults and their caregivers with
accessing services and information; provide relief to family caregivers so that they can continue
their caregiving; and allow older adults to remain actively engaged with their communities.
The Study Commission on Aging recognizes the importance of the services provided through the
Home and Community Care Block Grant and supports increased funding through enactment of
2007- SHz- 24.
Recommendation 3: Funds for Project C. A. R. E.
The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000, to
the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty)
which provides support to individuals with dementia and their caregivers.
Background 3: Support Project C. A. R. E.
Providing funding for Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) was the
most frequently mentioned item during the public hearing in Jamestown and the third most
frequently mentioned item during the presentations to the Commission by organizations
representing older adults. The Governor's Advisory Council and the Senior Tar Heel Legislature
both mentioned this item as a legislative priority for their organizations.
In 2007, the Study Commission on Aging recommended that the General Assembly appropriate
$ 500,000 to the Department of Health and Human Services, Division of Aging and Adult Services,
for the 2007- 2008 fiscal year, and $ 500,000 for the 2008- 2009 fiscal year, to fund Project C. A. R. E.
which provides support to individuals with dementia and their caregivers. In response to this
recommendation, SB 165 and HB 96 were introduced during the 2007 Session and referred to
Appropriation Committees, but did not receive further action.
A statistical abstract, " 2008 Alzheimer's Disease Facts & Figures," of US data on Alzheimer's
disease published by the Alzheimer's Association recently reported that it is anticipated that
between 2000 and 2010, North Carolina will experience a 31% increase in the number of people
age 65+ with Alzheimer's disease. According to the report, in 2007, there were 311,578
Alzheimer/ dementia caregivers providing 268,953,971 hours of unpaid care per year with an
economic value of $ 2,845,533,016. The report notes that in 2005, Alzheimer's disease was the
seventh- leading cause of death for people of all ages and the fifth- leading cause of death for people
age 65 and over.
The Commission heard a presentation on Project C. A. R. E. during the meeting on February 28,
2008. The goal of Project C. A. R. E. is to increase quality, access, choice, and use of respite and
support services to low- income rural and minority families caring for a person with dementia at
home or within a hospital setting. The program is administered through the Division of Aging and
Adult Services with assistance from the Duke Aging Center Family Support Program. A Project
C. A. R. E. in- home visit: assesses the family care environment; identifies the needs and preferences
of both the caregiver and the person with dementia; facilitates discussion and mutual understanding
among family members; connects the family with community resources; and ensures the provision
of quality respite care and support services.
Project C. A. R. E. began with the Alzheimer's Association, Western Chapter, in 2001. Funding thus
far has been provided by the U. S. Administration on Aging's Alzheimer's Disease Demonstration
Grants, leveraged through grants provided by private foundations, and supplemented by Family
Caregiver Support Programs. Initially, the program served six ( 6) counties. There are currently
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 29
three ( 3) Project C. A. R. E. pilot sites set up to serve 14 counties: Charlotte ( Mecklenburg County);
Winston- Salem ( Forsyth, Surry, and Stokes); and Asheville ( Polk, Henderson, Transylvania,
Rutherford, Madison, McDowell, Buncombe, Haywood, Jackson, and Swain). The program
received national recognition as a model and best practice in 2004 and 2005. Grant funding is no
longer an option for this particular program and State funding is needed to continue the program.
The total budget for the program is $ 433,333, which includes a 25% local match. The federal
funding portion of that total is $ 325,000 and will end June 30, 2008. The Department of Health
and Human Services, Division of Aging and Adult Services, needs $ 500,000 to sustain Project
C. A. R. E. activities in 14 western and piedmont counties. If $ 500,000 is appropriated, there would
be a 25% matching requirement in the amount of $ 166,666, for total funds amounting to $ 666,666.
It is anticipated that the level of local interest and current activity in services in the 14- county area
will yield sufficient funding to meet matching requirements. A possible advantage to this
appropriation is that if the State funds the existing program infrastructure and service capacity,
North Carolina may be eligible to receive grants to replicate Project C. A. R. E. in Eastern North
Carolina, moving toward the ultimate goal of statewide expansion.
The Study Commission on Aging appreciates caregivers, recognizes the importance of respite,
supports State funding for Project C. A. R. E., and therefore encourages enactment of 2007- SHz- 25.
Recommendation 4: Adult Protective Services Pilot Program
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087,
to the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed
changes to the adult protective services statutes and to report to the Study Commission on Aging on
the evaluation of the pilot by March 1, 2010.
Background 4: Adult Protective Services Pilot Program
Support for Adult Protective Services/ Enact and Fund the Adult Protective Services ( APS)
Clearinghouse Model Pilot was the fourth most frequently mentioned item during the organization
presentations on February 28, and was among the most frequently mentioned items during the
public hearings in Wilson and Jamestown.
In 2007, the Study Commission on Aging recommended that the General Assembly appropriate
$ 1,492,000 to the Department of Health and Human Services, Division of Aging and Adult
Services, for the 2007- 2008 fiscal year and $ 1,930,000 for the 2008- 2009 fiscal year to enact a pilot
program to assess proposed changes to the adult protective services statutes and to report on the
evaluation of the pilot by March 1, 2009. In response to this recommendation, HB 198 and SB 108
were introduced and referred to Appropriations Committees, but no further action was taken.
S. L. 2005- 23 directed the Adult Protective Services ( APS) Task Force to collaborate with
stakeholders and others interested in improving APS and to report those findings to the Study
Commission on Aging and the House Study Committee on Guardianship Laws. The APS
Clearinghouse Model: NC's System of Protection, is the product of a collaborative effort among the
Division of Aging and Adult Services, the NC Association of County Directors of Social Services,
representatives from the Attorney General's office, stakeholders, and other interested parties. The
goals of the APS Clearinghouse Model are to: increase North Carolina's ability to reach out to
citizens to offer voluntary services; enable North Carolina to respond to high risk situations before
harm occurs and provide the opportunity to assist older adults who are victimized, but not
incapacitated; allow APS to intervene before the adult's health deteriorates to life- threatening
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 30
levels; and allow APS to provide information and services to a greater number of adults.
Exploring feasibility of the APS Clearinghouse Model requires implementation of a pilot. The
pilot will require funding for staff in county departments of social services to carry out the pilot,
and funding for three ( 3) staff positions in the Division of Aging and Adult Services ( DAAS) to
plan and conduct the pilot. The total budget for the APS Pilot in the 2008- 2009 fiscal year is
$ 1,497,087, broken down as follows: $ 1,212,805 for county staff ( 24.103 FTEs for 9- months),
$ 159,532 for DAAS staff ( 3.0 FTEs for 9- months), $ 18,000 for public education, $ 6,750 for
essential services, and $ 100,000 for evaluation of the pilot. An additional $ 1,930,107 is needed for
the 2009- 2010 fiscal year which would be utilized for the following: $ 1,617,308 for county staff,
$ 188,049 for DAAS staff, $ 18,000 for public education, and $ 6,750 for essential services, and
$ 100,000 for evaluation of the pilot.
The Study Commission on Aging realizes the vital importance of safeguarding our older adults and
supports the enactment of 2007- SHz- 26.
Recommendation 5: Statewide Aging Study
The Study Commission on Aging recommends support for a comprehensive, five- year statewide
study of the older adult population and the State's readiness to respond to the coming wave of older
adults by recommending that the General Assembly take the following steps: establish an
appointment process for a steering committee; appropriate $ 175,000 to the Department of Health
and Human Services, Division of Aging and Adult Services, for the establishment of two positions
to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult
Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the
Department of Health and Human Services, Division of Aging and Adult Services, to make annual
reports to the General Assembly on the status of the study.
Background 5: Statewide Aging Study
S. L. 2007- 355, Section 1, required several Divisions within the Department of Health and Human
Services to study programs and services for older adults in Brunswick, Buncombe, Gaston,
Henderson, Moore, and New Hanover Counties. These counties currently have, or are projected by
2030 to have, the largest numbers of individuals age 60+ when compared to individuals age 17 and
younger.
Since growth projections for the age 60+ population are anticipated to increase overall in North
Carolina, S. L. 2007- 355, Section 2, required the Division of Aging and Adult Services to make a
recommendation on a study to include all counties in North Carolina. The Division was required to
evaluate similar studies conducted by other states and to make recommendations on the criteria that
should be included and an appropriate funding level for a study to include all North Carolina
counties. On January 24, 2008, the Division made a report to the Commission on a statewide
study.
The report recommends the establishment of a steering committee to: oversee the design and
implementation of a consumer needs assessment and an expectations assessment; oversee the
design and implementation of a State and local awareness and preparedness assessment; identify
the need for and to obtain additional studies to supplement the information needed for
comprehensive planning; produce reports for the Governor and General Assembly to guide policy
and program development based on the findings of the assessments and studies; and to identify
action needed to ready North Carolina for its growing older adult population. The Committee
would be appointed by the General Assembly and the Governor.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 31
The report recommends two positions to support the steering committee: a Human Services
Planner/ Evaluator IV ( pay grade 74), and an Administrative Assistant III ( pay grade 67). The cost
for these positions is $ 175,000.
Use of a consumer survey is recommended in years one and four of the statewide study, for design,
implementation, analysis, and reporting associated with conducting a survey of consumer needs,
assets, and expectations. The anticipated cost is $ 200,000 for the 2008- 2009 fiscal year and
$ 175,000 for the 2011- 2012 fiscal year. ( It is anticipated that there would be some savings in
survey design the second year.) The report recommends funds for design, implementation, analysis
and reporting associated with conducting a survey of state and local governments at a cost of
$ 75,000 in the 2008- 2009 fiscal year, 2010- 2011 fiscal year, and 2012- 2013 fiscal year.
Additionally, the report recommends $ 75,000 per year to secure the services of consultants to
conduct special studies and otherwise support the work of the steering committee.
With regard to support for program services, the report recommends:
 $ 1,470,000 per year to strengthen the capacity of Area Agencies on Aging ( AAA) for
support of regional and local planning ( this includes restoring the $ 270,000 in recurring
AAA State support reduced in 2001, and adding a position at each AAA to facilitate
regional and community planning for aging at a cost of $ 1,200,000 million per year ( which
would total $ 1.6 million with a 25% match participation rate)).
 Awarding $ 20,000 to each county to aid the work of citizen- driven local aging leadership
planning teams for a total cost of $ 2,000,000 per year.
The Study Commission on Aging believes that it is necessary for the State to make preparations
now to care for the anticipated increase in the older adult population and supports a statewide study
of the State's readiness to respond through the enactment of 2007- SHz- 29.
Recommendation 6: Adult Care Home Residents
Recommendation 6a: Adult Care Home Admission Screening Process
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for
mental health and developmental disability conditions as part of the adult care home admission
process. The process shall duplicate the nursing facility admission process and shall consist of an
automated screening tool and where indicated a face- to- face assessment by a mental health or
developmental disabilities professional. The Division of Medical Assistance shall report on the
design, development, and piloting of the screening process for mental health and developmental
disability conditions as part of the adult care home admission process on or before October 15,
2008.
Recommendation 6b: Transitional Residential Treatment Program Pilot Sites
The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental
Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically
diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.
Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care
Workers in Adult Care Homes
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Health Service Regulation, Division of Medical
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 32
Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse
Services to work with adult care home providers to build on recent studies to determine the most
appropriate and cost effective way to provide training on the care of individuals with mental illness
to direct care workers in adult care homes by tailoring the training to resident assessment results
and utilizing web- based formats as appropriate, and to provide an interim report to the Study
Commission on Aging by November 1, 2008, and a final report by November 1, 2009.
Recommendation 6d. Assessment and Service Plan Development for Adult Care
Home Residents
The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance to support assessment and service plan development for adult care home
residents and to provide an interim report by November 1, 2008, and a final report by November 1,
2009.
Background 6: Adult Care Home Residents
S. L. 2007- 156 ( SB 164) directed the Department of Health and Human Services to study rules and
regulations regarding housing individuals with mental illness in the same facility vicinity as
individuals without mental illness, and to recommend staff training requirements for direct care
workers in adult care homes to provide appropriate care to residents with mental illness.
On March 28, 2008, the Commission heard a presentation of the report prepared in response to S. L.
2007- 156. The report provides an overview of how eight ( 8) other states handle placement of
mentally ill individuals in assisted living/ adult care home facilities; information on the limited use
of adult care home special care units for residents with mental health disorders; revisions to staffing
rules; recommendations and cost figures on the screening, assessment, and the provision of services
to mentally ill individuals in adult care homes; and proposed training recommendations and
associated costs.
The report indicates the percentage of residents with mental illness as compared to the total number
of residents. The report indicates that family care homes ( facilities with six or fewer beds) had in
the following years, the percentage of adults with mental illness: 2002 = 38.1%, 2003 = 52.7%,
2004 = 60%, 2005 = 44.4%, 2006 = 45.5%, and 2007 = 46.3%. Adult care homes ( seven or greater
beds) had in the following years, the percentage of adults with mental illness: 2002 = 18.2%, 2003
= 27.7%, 2004 = 30.8%, 2005 = 20.2%, 2006 = 20.2%, and 2007 = 19%.
The report provides a process to assess and provide care to meet the needs of adult care home
residents, especially mentally ill residents. The key first step to providing care is to assess the type
of care needed through the implementation of screening and assessment programs. Currently a
physician designates the appropriate level of care for a potential resident using the FL- 2 form. The
Department has developed the Medicaid Uniform Screening Tool ( MUST, Level I) which is
anticipated to replace the FL- 2 form in September 2008. If the MUST screening determines that
additional mental health assessment is needed, the individual would be referred for the Pre-
Admission Screening and Resident Review ( PASARR), Level 2 Assessment. The PASARR Level
2 Assessment will determine whether the individual needs a specialized mental health service.
According to the report, if a PASARR Level 2 assessment indicates that specialized mental health
services are needed, the Division of Mental Health, Developmental Disabilities and Substance
Abuse Services ( DMH/ DD/ SAS) will be notified and service needs will be communicated to the
Local Management Entity ( LME). The LME will then contact the individual. The Department
estimates the PASARR Level II costs for fiscal year 2008- 2009 as $ 1,764,000 and $ 281,840 on a
recurring basis.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 33
The report outlines the need for $ 580,000 to develop and automate a comprehensive assessment
and care plan system for residents in adult care homes. This assessment, care planning, and
training system is being developed through VieBridge, Inc. with funding from the North Carolina
Association Long Term Care Facilities ( NCALTCF). The NCALTCF and the Department of
Health and Human Services, Divisions of Health Service Regulation and Medical Assistance, have
worked in a collaborative arrangement on this system. The funding would be used to support the
assessment and care planning system for adult care home residents and statewide implementation is
anticipated January 1, 2009.
The report provides information on development of Transitional Residential Treatment Programs.
This new type of 6- bed residential facility would provide 24- hour residential treatment and
rehabilitation of adults who have a pattern of difficult behaviors related to mental illness which
exceed the capabilities of traditional community residential settings. The Department would like to
pilot three ( 3) sites at an annual cost of $ 378,056/ site and anticipates being able to utilize funds
beginning in January 2009. This would require an appropriation of $ 567,084 for FY 2008- 2009
($ 378,056 x 3 = $ 1,134,168 / 2= $ 567,084.)
The report outlines three layers of training: Two ( 2) hours of Basic Orientation training for all
facility staff; Twelve ( 12) hours of Specialized ( Phase Two) Training for aides and direct
supervisors of all facilities serving one or more persons with mental illness; and four ( 4) hours of
Annual Training for aides and direct supervisors of all facilities serving one or more persons with
mental illness. An annual cost of $ 4,500,00 was provided for the training.
The report also suggests the following to take place after screening and assessment: $ 334,000 for
PASAAR Level II assessments to determine specialized mental health care needs and $ 14,860,000
to develop capacity to care for adult care home residents needing mental health services.
After the April 10, 2008 meeting and approval of the Commission's initial recommendation on this
topic, the Department of Health and Human Services decided to scale back implementation of the
Medicaid Uniform Screening Tool ( MUST), which was the basis for the recommendation to
develop and implement PASARR, Level II screening prior to adult care home admission. Although
MUST will not be ready for Statewide implementation, the Department anticipates that it will have
a screening tool in place in by fall 2008, and that this initial screening tool will be able to identify
those residents that will need a face- to- face mental health evaluation. Therefore, the Commission is
recommending that the General Assembly appropriate $ 1,764,000 for FY 08- 09 to the Department
of Health and Human Services, Division of Medical Assistance, to design, develop, and implement
on a pilot basis, a screening process, for mental health and developmental disability conditions as
part of the adult care home admission process. It is anticipated that the process will duplicate the
nursing facility admission process and will consist of an automated screening tool and where
indicated a follow- up face- to- face assessment by a Mental Health or Developmental Disabilities
professional.
In it's report to the Commission, the Department provided that after a mental health assessment is
completed, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
( DMH/ DD/ SAS) staff would make the final determination about whether the individual needed
specialized mental health screening, contact the LME to arrange for services, and follow- up to be
sure services are provided. The report requested $ 334,000 for five additional positions to provide
this function. For the pilot implementation of the mental health evaluation contained in this
recommendation, it is anticipated that DMH/ DD/ SAS will absorb this function.
This revised recommendation also requires the Division of Medical Assistance, Division of Health
Service Regulation, and DMH/ DD/ SAS to report on the design, development, and piloting of the
screening process for mental health and developmental disability conditions as part of the adult care
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 34
home admission process in an interim report by October 15, 2008, with a final report due October
15, 2009. The Division's report must contain findings and recommendations to include: results on
how many individuals were received initial screening prior to admission, how many needed an
additional mental health evaluation, and how many of those screened were admitted to an adult care
home; a process chart of the screening for adult care home admissions, who performs the screening,
and turnaround times for each step in the process; whether there are delays due to pre- admission
screening and how these are handled; whether the process should be expanded to all adult care
home admissions on a Statewide basis; whether statutory or policy changes are needed for
Statewide implementation; and costs associated with Statewide implementation.
In an effort to begin to address the issue of mixed populations in adult care homes, the Study
Commission on Aging supports enactment of 2007- SHz- 31.
Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings
The Study Commission on Aging expresses support for the creation of a reward system for adult
care homes that achieve high ratings and at the appropriate time, the Commission anticipates
supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).
Background 7: Support for a Reward System for Adult Care Homes with High Ratings
In response to recommendations from the Study Commission on Aging, S. L. 2007- 544 was enacted
and Section 3 contained provisions related to a rating system for adult care homes. Section 3( d)
required the Department of Health and Human Services to study the structure and cost of a system
to reward adult care homes that receive high ratings and to report findings and recommendations to
the Study Commission on Aging no later than March 1, 2008.
On March 28, 2008, the Commission heard the report on the structure and cost of a system to
reward adult care homes receiving high ratings. The report recommended a system modeled after
the grant program for nursing homes that is funded on civil monetary penalties. According to the
report, the program for nursing homes, which was started in 1996, has been a highly successful,
cooperative effort among regulators, providers, advocates, and others to make facilities better
places for residents to live and better places for employees to work. Under North Carolina law,
fines collected from adult care homes are transferred to local education agencies and therefore, the
General Assembly would have to appropriate funds for the reward system for adult care homes.
The report recommends that an adult care homes that achieves a 4 Star Rating ( 100 points or higher
on two consecutive annual surveys by the Division of Health Service Regulation) would receive a
high rating and therefore eligible for the reward. The Star Rating System is effective January 2009,
thus January 2010 would be the first time facilities might be eligible for rewards, assuming a score
of 100 points during the 2009 cycle and during the 2010 cycle. The Department also requested an
administrative officer position at a cost of $ 50,000, to coordinate and administer the grants in
response to decisions made by a Grant Committee, which consists of adult care home stakeholders
including provider representatives, advocates, Division of Health Service Regulation staff, and
others. As such, the estimated costs for this reward system are $ 300,000 for FY 2009- 2010
($ 250,000 for rewards and $ 50,000 for the position) and $ 550,000 for the 2010- 2011 fiscal year.
The Study Commission on Aging supports rewarding adult care homes with high ratings.
Recommendation 8: Support for Respite Care
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Aging and Adult Services, to study the adequacy of
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 35
service standards and funding for group respite services, and whether opportunities exist to
streamline and enhance the provision of respite services; direct the Division of Medical Assistance,
Department of Health and Human Services, to study the feasibility of providing respite care as a
State Plan Service, and provide a report on both issues to the Commission on Aging by November
1, 2009.
Background 8: Support for Respite Care
S. L. 2007- 39 directed the Department of Health and Human Services to study the availability and
delivery of respite care. On March 28, 2008, the Commission heard a presentation on the
Department's report. The Department reported that there is a need for respite care and that the
provision of respite care is important for the State from an economic perspective. The report
provided an overview of the various respite programs available in North Carolina as well as
information on programs in other states. One of the issues noted was the fragmentation of services
both in North Carolina and other states. The fragmentation is due to varying eligibility criteria,
target client populations, regulatory requirements, programs, and funding streams. The report
suggested that, " While the fragmentation makes respite care more difficult to administer, it does
provide for the needs of a diverse population." Four model programs for respite care are defined in
the report: Project C. A. R. E, Jackson County Family Resource Center, A Small Miracle, Inc. and
Senior Companion Respite Program.
The report indicated that the study group did not see a need for separate statutory language for
respite care, but believed that consistent state funding was needed under the existing systems. The
study group agreed that respite care delivery could be enhanced if Medicaid included respite as a
State Plan Service. The report stated that, a respite service, defined as an Optional Medicaid State
Plan Service, should be offered to all who qualify, regardless of where the recipient lives or the
recipient's diagnosis, and should be based on needs. Further, the report suggested the State may
limit the definition, duration, and scope, and that an assessment of caregiver capability was integral
to the process. The report indicated that the Division of Medical Assistance would pursue an
internal review of this option. Additionally, the report supported study by the Division of Aging
and Adult Services, Department of Health and Human Services, on the place of group respite
programs in the long- term care continuum and the adequacy of service standards and funding.
The Commission supports caregivers and the provision of respite services and therefore
recommends the enactment of 2007- SQz- 11 to require the Department of Health and Human
Services continue to study ways to make respite care more accessible.
Recommendation 9: Study Older Adult Hearing Loss
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services to study the current and anticipated impact of hearing loss on North
Carolina's older adult population and the availability and access to qualified professionals for
treatment and hearing aid purchase assistance for low income individuals; to develop an inventory
of the technology available to assist individuals; and to evaluate resources and programs available
in other states, with a report to the Study Commission on Aging by November 1, 2008.
Background 9: Study Older Adult Hearing Loss
On April 10, 2008, the Commission heard a presentation from the Department of Health and
Human Services on hearing loss for older adults. Based on NC demographic information, the
Department of Health and Human Services, Division of Services for the Deaf and the Hard of
Hearing, estimated " the current hearing loss population among senior adults to be 166,420 for ages
65- 74 with a projected increase in 2030 to 342,897. For senior adults ages 75 and up, current
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 36
numbers indicate 207,483 persons with hearing loss and a projected increase to 438,801 for the
year 2030." Although hearing loss occurs at all ages, the Department shared that the National
Institute on Deafness and Other Communication Disorders ( NIDCD) reports that one ( 1) out of
every three persons by age 65 has some form of hearing loss. The Department's report highlighted
a lack of readily- available and accurate information on the impact, treatment, and adaptive
technology options for individuals with hearing loss. The lack of information is compounded by
the often gradual loss of hearing.
The Department pointed out the following issues faced by older adults with hearing loss:
 " Hearing Aids and Limited Insurance Coverage- One of the first challenges that the hard of
hearing person faces is the cost of hearing aids. These devices can often cost several thousand
dollars and are rarely covered by any insurance. Generally neither Medicare nor NC
Medicaid offer hearing aid coverage for adults. North Carolina along with bordering states of
Virginia, Kentucky, South Carolina, Georgia, and Tennessee are in the list of 16 states that do
not provide this coverage. In addition, there is virtually no insurance coverage for hearing
aids in North Carolina.
 Many people report difficulty finding a trustworthy professional to assist them with hearing
aids. The lack of a 30- day mandated trial period for hearing aids in North Carolina, one of 14
states without such a policy, instills in some individuals this lower level of trust toward the
hearing health care professional.
 A myriad of emotional responses resulting from difficulties in communicating often lead to
increased mental health concerns for senior adults. Better Hearing Institute reports that
hearing loss, particularly in older individuals not using hearing aid or assistive devices, has
been directly linked to short- term memory loss, fatigue, anxiety and depression.
 Among senior adults, hearing loss is one of the most prevalent and chronic, but treatable,
disabling condition[ s]. Hearing loss is ranked third, only behind arthritis and hypertension.
Hearing loss has also been linked to lower incomes— on average, those with hearing loss but
do not wear hearing aids earn up to $ 12,000 per year less than peers using hearing aids."
The Study Commission on Aging recognizes the challenges that hearing loss presents and
recommends the enactment of 2007- SQz- 12 to require the Department of Health and Human
Services study this issue and explore ways to provide assistance to individuals with hearing loss.
Recommendation 10: Criminal Background Checks for Nursing Home Administrators
The Study Commission on Aging recommends that the General Assembly enact legislation to give
the North Carolina Board of Nursing Home Administrators the authority to require a criminal
history record check for nursing home administrator license applicants.
Background 10: Criminal Background Checks for Nursing Home Administrators
G. S. 131E- 265 provides that an offer of employment by a nursing home to an applicant to fill a
position that does not require the applicant to have an occupational license is conditioned on
consent to a criminal history record check of the applicant.
G. S. 90- 278 gives the NC State Board of Examiners for Nursing Home Administrators the
authority to issue licenses to qualified persons as nursing home administrators. Therefore, a
criminal record background check is not required for nursing home administrators because they
have an occupational license.
On April 10, 2008, the Commission heard a presentation on this issue by the North Carolina State
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 37
Board of Examiners for Nursing Home Administrators who requested the ability to perform
criminal history record checks for nursing home administrator license applicants.
The Study Commission on Aging believes that it is imperative to provide safe and secure
environments in the State's long- term care facilities and supports allowing the North Carolina State
Board of Examiners for Nursing Home Administrators to require criminal history record checks for
nursing home administrator applicants through the enactment of 2007- RDz- 26.
Recommendation 11: Support Guardianship Study Recommendations
The Study Commission on Aging recommends that the General Assembly enact legislation to
authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in
determining drivers license revocation of an incompetent individual, and to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order, which are both based
on recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly.
Background 11: Support Guardianship Study Recommendations
The House Study Committee on State Guardianship Laws was established by the Speaker of the
House on February 17, 2006. The Committee was directed to submit a final report on the results of
its study on or before December 31, 2006.
In the final report, Finding 6 indicates that the Committee found that guardians currently have the
authority to sell up to $ 1,500 worth of personal property without a court order in order to meet the
monetary needs of the ward. The Committee further found that the amount of a ward's personal
property that guardians are allowed to sell is outdated and insufficient. As a result, the House
Study Committee on State Guardianship recommended that the total amount of personal property
that can be sold without a court order be increased to $ 15,000. In response to this recommendation,
House Bill 794 was introduced. A Committee Substitute for House Bill 794 received a favorable
report in the House Committee on Aging and was referred to House Judiciary II. It was not heard
in House Judiciary II and House Bill 794 is not eligible for consideration during the 2008 Session.
In the final report, Finding 7 indicates that the Committee on State Guardianship Laws found it
unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an
individual who has been declared incompetent. The Committee recommended that the Division of
Motor Vehicles be authorized to not automatically revoke the drivers license of an incompetent if
the clerk of superior court recommends the incompetent be allowed to retain the drivers license. In
response to this recommendation, House Bill 796 was introduced. House Bill 796 received a
favorable report in the House Committee on Aging and was referred to House Judiciary II. It was
not heard in House Judiciary II and House Bill 796 is not eligible for consideration during the 2008
Session.
On April 10, the Commission heard a presentation on guardianship and on the issues surrounding
an increase in the amount of a ward's personal property that a guardian can sell, and on the
automatic revocation of the driver license of an incompetent.
The Study Commission on Aging supports the work of the House Study Committee on State
Guardianship Laws and recommends the enactment of 2007- SHz- 27 to address drivers license
revocation of an incompetent individual, and enactment of 2007- SHz- 28 to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 38
Recommendation 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommends that the General Assembly enact House Bill 93,
Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to
study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines
for the installation and use of wheelchair tie- down systems, and to report findings and
recommendations to the Study Commission on Aging and the Joint Legislative Transportation
Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and
was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)
Background 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommended that the 2007 General Assembly direct the
Department of Transportation to study appropriate methods of transporting passengers seated in
wheelchairs, to develop guidelines for the installation and use of wheelchair tiedown systems, and
to report findings and recommendations to the Study Commission on Aging and the Joint
Legislative Transportation Oversight Committee. House Bill 93 and Senate Bill 57 were
introduced. House Bill 93 was referred to the Senate Committee on Transportation on March 13,
2007 and is still eligible for consideration during the 2008 Session.
This recommendation to the 2007 Session was based on a wheelchair transportation safety
restraints presentation made to the Commission on November 15, 2006. During the presentation,
the Commission learned that transportation of passengers seated in wheelchairs within motor
vehicles is a relatively new experience and that while certified passenger restraint systems are
mandated for adults and children seated in vans, there is no law regulating restraint systems for
persons seated in wheelchairs. The presentation pointed out that the majority of incidents involving
persons transported in wheelchairs occur during ordinary driving maneuvers without a collision.
Statistical tabulations often omit these events since police are rarely summoned and the injured are
driven for medical care by the vehicle operator. However, the Division of Facility Services
tabulates incident reports filed by nursing homes which yields the following insights: problems
occur despite well- intentioned efforts to secure the chairs and apply restraints; van operators lack
knowledge that wheelchairs must be specifically designed for use in vehicles, restraint systems
must be property attached to the chair, and restraint systems must be property applied to the
passenger seated in the chair; and finally, the situation resembles that of child safety restraints.
The report distributed to the Commission included letters from the following entities expressing
support for exploring the safe transport of individuals in wheelchairs: The University of North
Carolina Highway Safety Research Center, NC Health Care Facilities Association, AARP of North
Carolina, NC Coalition on Aging, the Governor's Advisory Council on Aging, and the Senior Tar
Heel Legislature.
The presentation offered the following solutions from research by the University of Michigan
Traffic Research Institute:
1) Whenever possible, transfer the rider to a seat and use the seatbelt.
2) If transfer to a seat is not possible, use a wheelchair and tiedown system that protects the
occupant.
a. Use a Transit Wheelchair ( WC/ 19 compliant) with securement points for tiedown
straps, arm rests that permit the lap belt to cross the pelvis and a shoulder strap to
cross the chest.
b. Secure the wheelchair to the vehicle with four tiedown straps.
Apply both lap and shoulder belts to the rider. The seatbelt must fit snugly cross the
pelvis and be anchored at a 45 degree angle on each side. The shoulder strap must be
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 39
in contact with the middle of the chest and shoulder and it must avoid contact with the
neck.
The Study Commission on Aging continues to support House Bill 93, a recommendation to the
2007 Session of the General Assembly, which requires a study of appropriate methods of
transporting passengers seated in wheelchairs.
Recommendation 13: Study Medically Needy Income Standard
The Study Commission on Aging recommends that the General Assembly enact House Bill 92,
Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,
Division of Medical Assistance, to study the medically needy income standard and determine the
best method of increasing the standard while providing improved consistency across long- term care
settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate
Appropriations and was a recommendation to the 2007 General Assembly from the Study
Commission on Aging.)
Background 13: Study Medically Needy Income Standard
The Study Commission on Aging recommended that the 2007 General Assembly direct the
Department of Health and Human Services to review options for increasing Medicaid Medically
Needy Income Limits. House Bill 92 and Senate Bill 110 were introduced. House Bill 92 was
referred to the Senate Committee on Appropriations on March 14, 2007 and is still eligible for
consideration during the 2008 Session.
This recommendation to the 2007 Session was based on presentations to the Commission on the
Medicaid Institutional Bias Study. The study was mandated by Section 10.3 of S. L. 2004- 124 for
the purpose of identifying any bias that favors support for individuals in institutional settings over
support for individuals living at home.
In response to a Commission recommendation, S. L. 2006- 110 was enacted and required the
Department of Health and Human Services to collaborate with providers and advocates of home
and community- based long- term care services to review the Institutional Bias Report and make
recommendations on ways to address the identified biases. On December 13, 2006, the
Commission heard a presentation on recommendations to address two of the biases. One of the
identified biases stated that medically needy requirements leave little money for persons to pay for
living expenses if they prefer to remain in the community, whi

NORTH CAROLINA
STUDY COMMISSION ON AGING
REPORT TO THE
GOVERNOR AND THE 2008 REGULAR SESSION OF THE
2007 GENERAL ASSEMBLY
A LIMITED NUMBER OF COPIES OF THIS REPORT IS AVAILABLE
FOR DISTRIBUTION THROUGH THE LEGISLATIVE LIBRARY.
ROOMS 2126, 2226
STATE LEGISLATIVE BUILDING
RALEIGH, NORTH CAROLINA 27611
TELEPHONE: ( 919) 733- 7778
OR
ROOM 500
LEGISLATIVE OFFICE BUILDING
RALEIGH, NORTH CAROLINA 27603- 5925
TELEPHONE: ( 919) 733- 9390
North Carolina
Study Commission On Aging
May 12, 2008
To: Governor Michael Easley
Lieutenant Governor Beverly Perdue, President of the North Carolina Senate
Senator Marc Basnight, President Pro Tempore of the North Carolina Senate
Representative Joe Hackney, Speaker of the North Carolina House of Representatives
Members of the 2008 Regular Session of the 2007 General Assembly
Attached is a report from the North Carolina Study Commission on Aging submitted pursuant to
North Carolina General Statute § 120- 187. The report contains recommendations and proposed
legislation from the North Carolina Study Commission on Aging based on study conducted after
the adjournment of the 2007 Regular Session of the General Assembly.
Respectfully submitted,
___________________________ ___________________________
Senator Vernon Malone Representative Jean Farmer- Butterfield
Co- Chair Co- Chair
1
North Carolina Study Commission On Aging
2007- 2008 Membership List
President Pro Tempore's Appointments Speakers' Appointments
Senator Vernon Malone, Co- Chair Representative Jean Farmer- Butterfield, Co- Chair
Senator Stan Bingham Representative Alice Bordsen
Senator Katie Dorsett Representative Joe Boylan
Senator James Forrester Representative Bob F. England, MD
Senator A. B. Swindell, IV Representative Garland Pierce
Mr. Anthony Peace Ms. Karen Gottovi
Mr. Judy Pelt Mr. David Lowa
Ms. Jean Reaves Mr. Edd Nye
Ex Officio:
Mr. Jackie Sheppard, Assistant Secretary,
Long Term Care and Family Services,
Department of Health and Human Services
Clerks:
Bonnie McNeil
919/ 733- 5880
Ruth Merkle
919/ 733- 5898
Staff:
Theresa Matula,
Shawn Parker,
Ben Popkin
Research Division
919/ 733- 2578
2
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 3
TABLE OF CONTENTS
LETTER OF TRANSMITTAL...................................................................................................... 1
MEMBERSHIP LIST...................................................................................................................... 2
PREFACE ............................................................................................................................... ........ 6
EXECUTIVE SUMMARY ............................................................................................................. 7
AGING NORTH CAROLINA: THE 2008 PROFILE ................................................................ 11
COMMISSION PROCEEDINGS .................................................................................................. 20
COMMISSION RECOMMENDATIONS..................................................................................... 26
APPENDICES
APPENDIX A.............................................................................................................................. .... 44
2007 Recommendation Status Report
Summary of Substantive Legislation Related to Aging, 2006 Session
APPENDIX B ............................................................................................................................... .. 67
Summary of Issues Most Frequently Mentioned by Organizations Representing Older Adults
APPENDIX C ............................................................................................................................... .. 73
Summary of 2008 Public Hearings
APPENDIX D.............................................................................................................................. .... 77
Legislative Proposals/ Bills
2007- SHZ- 23 AN ACT TO APPROPRIATE ADDITIONAL FUNDS TO THE SENIOR CENTER
GENERAL PURPOSE FUND, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2007- SHZ- 24 AN ACT TO APPROPRIATE ADDITIONAL FUNDS FOR THE HOME AND
COMMUNITY CARE BLOCK GRANT, AS RECOMMENDED BY THE NORTH CAROLINA
STUDY COMMISSION ON AGING.
2007- SHZ- 25 AN ACT TO APPROPRIATE FUNDS FOR PROJECT C. A. R. E. ( CAREGIVER
ALTERNATIVES TO RUNNING ON EMPTY) WHICH PROVIDES CONSUMER- DIRECTED
RESPITE CARE AND COMPREHENSIVE SUPPORT TO DEMENTIA CAREGIVERS WITH A
GOAL OF INCREASING RESPITE AND SUPPORT SERVICES TO LOW- INCOME RURAL AND
MINORITY CAREGIVERS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY
COMMISSION ON AGING.
2007- SHZ- 26 AN ACT TO APPROPRIATE FUNDS TO ENACT A PILOT PROGRAM TO ASSESS
CHANGES PROPOSED BY THE ADULT PROTECTIVE SERVICES TASKFORCE WITH A GOAL
OF IMPROVING NORTH CAROLINA'S SYSTEM OF RESPONDING TO ALLEGATIONS OF
ABUSE, NEGLECT, EXPLOITATION, OR SUBSTANTIAL RISK OF VULNERABLE OR ELDER
ADULTS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 4
2007- SHZ- 29 AN ACT TO PROVIDE A COMPREHENSIVE FIVE- YEAR STATEWIDE STUDY OF
THE STATE'S READINESS TO RESPOND TO THE COMING WAVE OF OLDER ADULTS BY
ESTABLISHING A STEERING COMMITTEE FOR THE STUDY, APPROPRIATING FUNDS TO
PROVIDE STAFF TO SUPPORT THE COMMITTEE, AND APPROPRIATING FUNDS FOR THE
FIRST YEAR OF THE STUDY, AS RECOMMENDED BY THE STUDY COMMISSION ON
AGING.
2007- SHZ- 31 AN ACT TO APPROPRIATE FUNDS FOR AN ADULT CARE HOME SCREENING
PROCESS FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITY CONDITIONS,
APPROPRIATE FUNDS FOR TRANSITIONAL RESIDENTIAL TREATMENT PROGRAM PILOT
SITES, APPROPRIATE FUNDS TO SUPPORT ASSESSMENT AND SERVICE PLAN
DEVELOPMENT IN ADULT CARE HOMES, AND TO STUDY SUITABLE METHODS TO
PROVIDE DIRECT CARE WORKERS WITH TARGETED AND COST EFFECTIVE TRAINING ON
THE CARE OF INDIVIDUALS WITH MENTAL ILLNESS, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
2007- SQZ- 11 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
STUDY ISSUES RELATING TO RESPITE CARE, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
2007- SQZ- 12 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
STUDY ISSUES RELATING TO HEARING LOSS IN OLDER ADULTS IN NORTH CAROLINA,
AS RECOMMENDED BY THE STUDY COMMISSION ON AGING.
2007- RDZ- 26 AN ACT TO AUTHORIZE THE NORTH CAROLINA STATE BOARD OF EXAMINERS
FOR NURSING HOME ADMINISTRATORS TO OBTAIN CRIMINAL HISTORY RECORD
CHECKS OF APPLICANTS FOR LICENSURE AS NURSING HOME ADMINISTRATORS, AS
RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2007- SHZ- 27 AN ACT TO RAISE THE CEILING ON THE TOTAL AMOUNT OF PERSONAL
PROPERTY A GUARDIAN IS ALLOWED TO SELL WITHOUT A COURT ORDER UNDER THE
LAWS PERTAINING TO GUARDIANSHIP, AS RECOMMENDED BY THE HOUSE STUDY
COMMITTEE ON STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.
2007- SHZ- 28 AN ACT AUTHORIZING THE DIVISION OF MOTOR VEHICLES TO CONSIDER
RECOMMENDATIONS FROM THE CLERK OF COURT IN DETERMINING WHETHER TO
REVOKE THE DRIVERS LICENSE OF A PERSON ADJUDICATED INCOMPETENT UNDER THE
GUARDIANSHIP LAWS, AS RECOMMENDED BY THE HOUSE STUDY COMMITTEE ON
STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.
HB 93 AN ACT TO DIRECT THE DEPARTMENT OF TRANSPORTATION TO STUDY ISSUES
RELATING TO INDIVIDUALS BEING TRANSPORTED IN VEHICLES WHILE SEATED IN
WHEELCHAIRS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON
AGING.
HB 92 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO
REVIEW OPTIONS FOR INCREASING MEDICAID MEDICALLY NEEDY INCOME LIMITS, AS
RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.
2007- SQFZ- 14 AN ACT TO INCREASE THE LONG TERM CARE INSURANCE TAX CREDIT, AS
RECOMMENDED BY THE STUDY COMMISSION ON AGING.
2007- SQFZ- 15 AN ACT TO REQUIRE MULTIUNIT ASSISTED HOUSING WITH SERVICES ( MAHS)
PROGRAMS TO REGISTER ANNUALLY WITH THE DIVISION OF HEALTH SERVICE
REGULATION AND TO AUTHORIZE THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES TO ESTABLISH CERTAIN FEES, AS RECOMMENDED BY THE STUDY
COMMISSION ON AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 5
2007- SHZ- 30 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES,
DIVISION OF AGING AND ADULT SERVICES, AND DIVISION OF MEDICAL ASSISTANCE,
TO STUDY IMPLEMENTATION OF AN INCOME DISREGARD POLICY FOR CURRENT
STATE/ COUNTY SPECIAL ASSISTANCE AND MEDICAID RECIPIENTS WHO ARE
ADVERSELY IMPACTED DUE TO COST OF LIVING OR OTHER INCOME INCREASES, AS
RECOMMENDED BY THE STUDY COMMISSION ON AGING.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 6
PREFACE
Chapter 120, Article 21, of the North Carolina General Statutes, charges the North Carolina Study
Commission on Aging with studying and evaluating the existing system of delivery of State
services to older adults, and recommending an improved system of delivery to meet the present and
future needs of older adults. The Commission consists of 17 members. Of these members, eight
are appointed by the Speaker of the House of Representatives, eight are appointed by the President
Pro Tempore of the Senate. The Secretary of the Department of Health and Human Services, or the
Secretary’s designee, serves as an ex officio, non- voting member.
This report represents the work of the North Carolina Study Commission on Aging during the 2007-
2008 interim. The Commission met on five occasions and held public hearings in Wilson and
Jamestown. During a meeting on February 28, 2008, the Commission heard brief presentations on
issues of interest or concern to organizations that represent older adults. The public hearings,
conducted in March and April, provided citizens with an opportunity to speak to Commission
members about programs and services for older adults. Based on reports received by the
Commission, input from organizations that represent older adults, and comments expressed by
citizens, the Study Commission on Aging presents the recommendations contained in this report.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 7
EXECUTIVE SUMMARY
The North Carolina Study Commission on Aging met five times and conducted two public hearings
during the 2007- 2008 interim. In response to the study and evaluation of services to older adults,
the North Carolina Study Commission on Aging makes the following recommendations to the
Governor and the 2008 Session of the 2007 General Assembly:
Recommendation 1: Senior Center Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent
that it shall become part of the continuation budget.
Recommendation 2: Additional HCCBG Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 2,500,000 to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the
Home and Community Care Block Grant ( HCCBG).
Recommendation 3: Funds for Project C. A. R. E.
The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000 to
the Department of Health and Human Services, Division of Aging and Adult Services, for the 2008-
2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) which
provides support to individuals with dementia and their caregivers.
Recommendation 4: Adult Protective Services Pilot Program
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087
to the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed changes
to the adult protective services statutes and to report to the Study Commission on Aging on the
evaluation of the pilot by March 1, 2010.
Recommendation 5: Statewide Aging Study
The Study Commission on Aging recommends support for a comprehensive, five- year statewide
study of the older adult population and the State's readiness to respond to the coming wave of older
adults by recommending that the General Assembly take the following steps: establish an
appointment process for a steering committee; appropriate $ 175,000 to the Department of Health
and Human Services, Division of Aging and Adult Services, for the establishment of two positions
to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult
Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the Department
of Health and Human Services, Division of Aging and Adult Services, to make annual reports to the
General Assembly on the status of the study.
Recommendation 6: Adult Care Home Residents
Recommendation 6a: Adult Care Home Admission Screening Process
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 8
mental health and developmental disability conditions as part of the adult care home admission
process. The process shall duplicate the nursing facility admission process and shall consist of an
automated screening tool and where indicated a face- to- face assessment by a mental health or
developmental disabilities professional. The Division of Medical Assistance shall report on the
design, development, and piloting of the screening process for mental health and developmental
disability conditions as part of the adult care home admission process on or before October 15,
2008.
Recommendation 6b: Transitional Residential Treatment Program Pilot Sites
The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084, for
2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental
Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically
diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.
Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care
Workers in Adult Care Homes
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Health Service Regulation, Division of Medical
Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse
Services to work with adult care home providers to build on recent studies to determine the most
appropriate and cost effective way to provide training on the care of individuals with mental illness
to direct care workers in adult care homes by tailoring the training to resident assessment results and
utilizing web- based formats as appropriate, and to provide an interim report to the Study
Commission on Aging by November 1, 2008, and a final report by November 1, 2009.
Recommendation 6d. Assessment and Service Plan Development for Adult Care Home
Residents
The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000, for
the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Medical
Assistance, to support assessment and service plan development for adult care home residents and
to provide an interim report by November 1, 2008, and a final report by November 1, 2009.
Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings
The Study Commission on Aging expresses support for the creation of a reward system for adult
care homes that achieve high ratings and at the appropriate time, the Commission anticipates
supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).
Recommendation 8: Support for Respite Care
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Aging and Adult Services, to study the adequacy of
service standards and funding for group respite services, and whether opportunities exist to
streamline and enhance the provision of respite services; direct the Division of Medical Assistance,
Department of Health and Human Services, to study the feasibility of providing respite care as a
State Plan Service, and provide a report on both issues to the Commission on Aging by November
1, 2009.
Recommendation 9: Study Older Adult Hearing Loss
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services to study the current and anticipated impact of hearing loss on North
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 9
Carolina's older adult population and the availability and access to qualified professionals for
treatment and hearing aid purchase assistance for low income individuals; to develop an inventory
of the technology available to assist individuals; and to evaluate resources and programs available
in other states, with a report to the Study Commission on Aging by November 1, 2008.
Recommendation 10: Criminal Background Checks for Nursing Home Administrators
The Study Commission on Aging recommends that the General Assembly enact legislation to give
the North Carolina Board of Nursing Home Administrators the authority to require a criminal
history record check for nursing home administrator license applicants.
Recommendation 11: Support Guardianship Study Recommendations
The Study Commission on Aging recommends that the General Assembly enact legislation to
authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in
determining drivers license revocation of an incompetent individual, and to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order, which are both based
on recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly.
Recommendation 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommends that the General Assembly enact House Bill 93,
Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to
study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines
for the installation and use of wheelchair tie- down systems, and to report findings and
recommendations to the Study Commission on Aging and the Joint Legislative Transportation
Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and
was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)
Recommendation 13: Study Medically Needy Income Standard
The Study Commission on Aging recommends that the General Assembly enact House Bill 92,
Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,
Division of Medical Assistance, to study the medically needy income standard and determine the
best method of increasing the standard while providing improved consistency across long- term care
settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate
Appropriations and was a recommendation to the 2007 General Assembly from the Study
Commission on Aging.)
Recommendation 14: Long Term Care Insurance Tax Credit
The Study Commission on Aging recommends that the General Assembly increase the Long- Term
Care Insurance Tax Credit to 75% of the premiums paid by the purchaser up to a maximum of
$ 1000.
Recommendation 15: Establish MAHS Registration Fee/ Penalty for Failing to Register
The Study Commission on Aging recommends that the General Assembly enact legislation to
require facilities meeting the definition of multiunit assisted housing with services ( MAHS) register
annually with the Division of Health Services Regulation, authorize the Division to charge a fee of
up to $ 350 per registration, and make it a Class 3 misdemeanor punishable only by fine for failing
to register.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 10
Recommendation 16: Special Assistance Income Disregard Study
The Study Commission on Aging recommends the Department of Health and Human Services,
Division of Aging and Adult Services, and Division of Medical Assistance, study whether North
Carolina can implement an income disregard policy for current Special Assistance and Medicaid
recipients who are adversely impacted due to cost of living or other income increases.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 11
Aging North Carolina:
The 2008 Profile
Prepared by the Department of Health and Human Services, Division of Aging and Adult Services
North Carolina’s Demographic Shift
North Carolina remains in the midst of a significant demographic change as the state’s 2.3 million
baby boomers ( those born between 1946 and 1964) are beginning to enter retirement age. Today,
the proportion of the state’s population who are seniors, ages 65 and older, is roughly 12 percent.
By 2030, when the youngest baby boomers are retirement age, the proportion should reach 17.7
percent, or 2.1 million older North Carolinians. The Baby Boomer Milestones table below shows
the milestones of the baby boomers expressed in terms of some major federal and state age- related
programs ( eligibility age in parenthesis). For example, last year ( 2006), the oldest boomers ( i. e.,
born in 1946) became eligible to receive services under the Older Americans Act, and as of January
of this year, some of the oldest boomers began receiving their first Social Security payments.
Table: Baby Boomer Milestones
Year when oldest boomers become eligible
Programs 2006 2007 2008 2009 2010 2011 2012
NC Senior Games participation ( 55)
Older Americans Act services ( 60)
Social Security at a reduced rate ( 62)
Medicare benefits ( 65)
Medicaid assistance for the Aged ( 65)
Full Social Security ( 66)
Figure A: Growth of Older North Carolinians Age 65+ ( 2000- 2030)
969,048 971,058
1,606,894
2,144,843
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
2000 2010 2020 2030
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 12
Figure A indicates the projected growth of North Carolinians age 65+ from the year 2010 to the
year 2030. [ 1] The impact of the aging baby boomers is clearly indicated. As the graph shows, there
is little expected growth in the older population between 2000 and 2010. This is because the Great
Depression and World War II were times when the entire country experienced the lowest birth rates
the country had ever experienced up until that time. The small number of people born during those
two times ( 1929 to 1945) will be 65 to 81 years old in 2010. However, due to retirement migration
to North Carolina, we will not see an actual decline in the number of older adults in that period, as
some states will, but the growth will be modest.
Figure B shows the projected growth of the older population by county between 2000 and 2030.
During this period, growth for the state as a whole is projected at 50 percent, while the population
65 and older is expected to grow 121 percent, and the population 85 and older is expected to grow
144 percent. [ 1]
The eight counties with more than 200 percent growth can be divided into two very different
categories. Union, Wake, Johnston, and Hoke counties are experiencing rapid growth in their
overall population as expanding parts of metropolitan areas, and they will remain relatively “ young”
( the proportion of their population projected to be over 65 is lower than that of the state as a whole.)
The remaining four counties— Brunswick, Camden, Currituck, and Dare— by contrast, are projected
to see disproportionate growth in their aging population. Brunswick and Dare, in particular, are
projected to have substantially higher percentages of older adults ( 26.4 percent and 24.1 percent
respectively), compared to 17.7 percent for the state as a whole.
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Guilford Franklin
Harnett
Hoke
Johnston
Lee
Montgomery
Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
Greater than 200%
100 to 199% increase
43 to 99% increase
Figure B. Projected Growth of Population Ages 65 and Older from 2000 to 2030
Based on 2000 Census counts ( www. census. gov) and April 2030 projections ( 2006, Demographic Unit, Office
of State Budget and Management
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 13
Figure C. Percent of County Population Projected to Be Ages 65 and Older in 2030
Figure C shows the counties that will have the largest concentration of older adults in 2030. All are
in areas attractive to retirees, but many are also counties that will continue to lose younger residents
because of modest economic opportunities.
Although decreases in both fertility and mortality are the major factors in the aging of the state’s
population, migration also plays a key role. The following factors contribute to the different rates
of aging in the state’s 100 counties [ 2]:
 Rural- to- urban migration of young adults continues to age rural counties.
 Large metropolitan counties attract large numbers of persons from outside the state as well
as from rural counties.
 Large metropolitan counties are experiencing greater growth among younger adults than
they are among older adults.
 A large number of older adults with higher incomes are retiring in some western and coastal
counties, as well as other select counties with attractions to specific groups of older adults
( e. g., golf courses).
As shown in Figure D, North Carolina ranked third nationally as a retirement migration destination
with a net migration number of 34,290 among older adults ( 60+) in the five- year period between
1995 and 2000. Along with other Sunbelt states ( Florida, South Carolina, Texas, Tennessee,
Georgia, and Virginia), North Carolina remains a popular destination for people of all ages,
including seniors. [ 3] The latest data estimate is that 30,491 older adults ( 60+) relocated to North
Carolina from other states and abroad, in just one year, between 2005 and 2006 [ 4]. That means
that in 2006, two percent of people age 60 and older currently residing in North Carolina had been
living in another state the previous year.
New
Alexander
Alleghany
Ashe
Avery
Buncombe
Burke
Cabarrus
Caldwell
Catawba
Cherokee
Cleveland
Davie
Gaston
Graham
Haywood
Henderson
Iredell
Jackson
McDowell
Macon
Madison
Mecklenburg
Mitchell
Polk
Rowan
Rutherford
Surry
Swain
Union
Watauga Wilkes
Yadkin
Yancey
Clay
Transylvania
Lincoln
Granville
Nash
Alamance
Anson
Bladen
Caswell
Chatham
Columbus
Cumberland
Davidson
Durham
Forsyth Guilford Franklin
Harnett
Hoke
Johnston
Lee
Montgomery
Moore
Orange
Person
Randolph
Richmond
Robeson
Rockingham
Sampson
Scotland
Stanly
Stokes
Vance
Wake
Warren
Beaufort
Bertie
Carteret
Chowan
Craven
Dare
Duplin
Edgecombe
Gates
Greene
Halifax Hertford
Hyde
Jones
Lenoir
Martin
Hanover
Northampton
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Pitt
Tyrrell
Brunswick
Washington
Wayne
Wilson
Camden
Currituck
More than 25% aged 65+
20 to 24.9% aged 65+
Less than 20% aged 65+
Note: The proportion in the state is 17.7%
Based on April 2030 projections ( 2006, Demographic Unit, Office of State Budget and Management
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 14
Figure D: Top Ten States with Net Number of Migrants Age 60+ ( 1995- 2000)
221,778
80,671
34,290 33,893 27,588 24,771 17,782 15,017 10,260 8383
0
50,000
100,000
150,000
200,000
250,000
FL AZ NC NV SC TX TN GA VA MO
States
Net Number of Migrants Age 60+
According to the most recent life tables from the North Carolina State Center for Health Statistics, if
age- specific mortality remains unchanged, babies born today in North Carolina are expected to live,
on average, to the age of 75.6 years. The North Carolinians who are age 60 today are expected to
live, on average, an additional 20.8 years to almost 81 years old. Generally, women live longer than
men and whites live longer than persons of other racial groups. However, at the oldest ages,
African Americans, in particular, have a life expectancy that is the same or slightly greater than that
of whites. This is known as the “ crossover effect.” [ 5]
Life Expectancies ( in Years) by Age Group, Gender, and Race
NC White All other Races*
Age Groups Combined Male Female Male Female
( At Birth) 75.6 73.8 79.6 68.0 75.8
60- 64 20.8 19.0 22.9 16.8 21.5
65- 69 17.1 15.4 18.9 13.8 17.8
70- 74 13.7 12.2 15.1 11.1 14.5
75- 79 10.6 9.3 11.6 8.8 11.4
80- 84 7.9 6.8 8.5 6.7 8.6
85+ 5.4 4.5 5.7 4.8 6.0
* This group is primarily African American, but other much smaller racial groups including Asian and
American Indian, are included. Source: NC Center for Health Statistics ( 2002). Healthy Life Expectancy in
North Carolina, 1996- 2000
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 15
What Are the Implications of this Shift?
The aging of the population is a national and international trend, and North Carolina, like the rest of
the world, must be prepared to reap the benefits and face the challenges of an older population.
Government faces decisions about the allocation of public resources from a tax base that may
experience slowed growth, especially in many aging rural counties. People must consider living
and caregiving arrangements in light of smaller nuclear and extended families. The health, human
service, employment, and education systems must adapt to the changing needs and interests of the
seniors of today and tomorrow. The business and faith communities as well as others must identify
and respond to the challenges and opportunities of these demographic shifts.
In the 2003- 2007 State Aging Services Plan, the Division of Aging and Adult Services, Department
of Health and Human Services, introduced a new initiative– Livable and Senior- Friendly
Communities– to raise awareness of the aging of our population. The initiative was also designed to
encourage North Carolina’s communities to become more senior- friendly, and livable for all people,
through collaboration among citizens, agencies, organizations, and programs, in both the public and
private arenas. This initiative formed the core around which the 2007– 2011 State Aging Services
Plan was organized. A livable and senior- friendly community in North Carolina will draw on the
talents and resources of active seniors while enhancing services for those who are vulnerable
because of their health, economic hardships, social isolation, or other conditions. A livable and
senior- friendly community will work to address a wide range of issues and concerns ( e. g., air
quality, housing, long- term care services, employment, enrichment opportunities) that, as a whole,
affect the quality of life of seniors and others in the community. Also, a livable and senior- friendly
community will assure good stewardship of its resources to meet the needs of today’s seniors, while
helping baby boomers and younger generations prepare for the future.
Demographic Highlights
Population
North Carolina ranks tenth among states in the number of persons age 65 and older and tenth in the
size of the entire population. [ 6] The fast pace of growth of the state’s older population is evident in
a US Census Bureau’s release in which North Carolina was ranked fourth nationally in the increase
of the number of older persons age 65+ ( 47,198 in NC) between April 2000 and July 2003. Only
three other states ( California, Texas, and Florida) reported a greater increase among their older
populations. Even so, when combined with the equally strong growth in other age groups, North
Carolina continues to maintain an overall healthy demographic balance among the generations, as it
is thirty- eighth among states in the proportion of the population over 65. [ 7]
 Estimated NC population age 65+ in 2006: 1,059,551 ( 12.0 percent of total population)
 Estimated NC population age 85+ in 2006: 132,412 ( 1.5 percent of the total population)
Diversity and Disparity
North Carolina is rich in diversity, but its citizens face challenges because of the disparity that exists
among all populations, including older adults. Some important differences among NC’s older
adults relate to gender, marital status, ethnicity/ race, residence, rurality, disability, health status,
grandparents raising grandchildren, and veteran status.
 Gender: Older women represent 59.8 percent of the 65+ age group and 72.4 percent of the 85+
age group. [ 8] The higher rate of poverty among older women remains a primary issue today.
For example, women age 75+ are twice as likely to be poor as men the same age. [ 9]
 Marital Status: Because men have shorter life expectancy, and because they tend to marry
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 16
younger women, at ages 65 and older, women are more than twice as likely to be unmarried as
men in their age group. [ 10] Data show that being unmarried ( widowed, divorced, separated,
or never married) increases a woman’s vulnerability to poverty. According to the Social
Security Administration, in 2005, 89% of married couples and 88% of nonmarried persons
aged 65 or older received Social Security benefits. Social Security was the major source of
income ( providing at least 50% of total income) for 54% of aged beneficiary couples and 72%
of aged nonmarried beneficiaries. It was 90% or more of income for 22% of aged beneficiary
couples and 42% of aged nonmarried beneficiaries. [ 11]
Percent of Unmarried Individuals by Age Group
Age 65- 74 Age 75- 84 Age 85+
Unmarried Women in NC 45.0 65.0 89.6
Unmarried Men in NC 20.9 26.0 41.4
Source: American Community Survey ( 2006). Table B12002.
 Ethnicity/ Race: Altogether 18.7 percent of persons age 65+ are members of ethnic minority
groups in North Carolina. [ 12] Compared to the nation as a whole, North Carolina’s
population age 65+ includes a larger proportion who are African American ( 15.6 percent in NC
compared to 8.3 percent nationally) and a smaller proportion of Latinos ( 1.2 percent in NC
compared to 6.4 percent nationally). American Indians, Asian Americans, and other ethnic
groups account for 2.0 percent of the age group 65 and older. In North Carolina, as well as
nationally, older adults from most ethnic minority groups show both a higher poverty rate and
a lower life expectancy when compared with the non- Latino white population. Poverty rates
for the two largest racial groups are shown in the table below. [ Note: See the Demographic
Shift section for the information on life expectancy.]
Percent Below Poverty Level for the Older Population of North Carolina
by Gender, Race, and Age Group
White African American
Male Female Male Female
Age Group 65 - 74 5.0 8.5 17.6 23.5
Age Group 75+ 6.5 12.6 21.9 35.0
Data from 2006 American Community Survey reflecting poverty in 2005.
 Residence: The 2000 Census showed that in North Carolina, 81.4 percent of householders age
65 and older owned their homes ( with or without mortgage), yet among homeowners in that
age group, over 61,000 reported incomes for 1999 that were below poverty. This figure
means that 11.8 percent of the homeowners over age 65 were poor, compared to 7.5 percent
for homeowners of all age groups. [ 13] This has implications for both helping some older
adults be responsible for their own needs ( e. g., reverse mortgages) and for the need for
property tax relief to older adults. Among renters age 65+ who provided information, 63.2
percent, or 72,739 households, spent more than 30 percent of their household income on rent
[ 14]. Furthermore, 5,000 North Carolina homeowners and renters age 65+ lacked complete
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 17
plumbing facilities in their homes. [ 15]
 Rurality: Among all age groups, 39.8 percent of North Carolina residents live in rural areas
compared to only 21.0 percent for the country as a whole. [ 16] The percentage among older
adults is no doubt higher ( based on the percentages of older adults in the predominantly rural
counties), but there is no age- specific figure available. In 2000, North Carolina's rural
population ( 3,202,238) was almost as large as the one in Texas ( 3,647,747), the state with the
largest number of rural residents in the nation. Not only was North Carolina's rural population
among the largest in terms of numbers, but the state also reported the highest proportion ( 39.8
percent) of rural population among the 20 most populous states in the nation. While 11 other
states reported higher proportions of rural population, ranging from 40.7 percent to 61.8
percent, all of these states are much smaller in total population than North Carolina. Thus,
North Carolina is unique among more populous states in having so large a rural contingency.
At the same time North Carolina has made the transition away from an agricultural economy
so that only 1.1 percent of its people live on farms, only slightly more than the 1.0 percent for
the nation as a whole. A 2002 report from Making a Difference in Communities ( MDC)
highlights a long list of challenges that rural residents and their communities face— isolation
by distance, lagging infrastructure, sparse resources that cannot adequately support education
and other public services, and weak economic competitiveness. [ 17]
 Disability: In North Carolina, 42.0 percent of the non- institutionalized civilian population ages
65 and older reported having one or more disabilities by the US Census definition— 45.5
percent of women and 40.7 percent of men, according to the 2006 American Community
Survey. [ 18] The Census Bureau defines disability as “ a long- lasting physical, mental, or
emotional condition that makes it difficult for a person to do activities such as walking,
climbing stairs, dressing, bathing, learning, or remembering. This condition can also impede a
person from being able to go outside the home alone or to work at a job or business.” This
definition is very broad and leads to counting a number of people who, indeed, have
difficulties but are able to function independently and would not meet the average person’s
perception of a person with a disability.
 Health Status: Heart disease is the leading cause of death among older adults both nationwide
and in North Carolina with cancer and stroke, second and third on the list. [ 19] In particular,
the coastal plain region of North Carolina has the fourth highest stroke death rate in the nation
and is labeled by some as the Buckle of the Stroke Belt [ 20]. African Americans and other
racial minorities are at substantially higher risk for certain chronic conditions such as heart
disease, stroke, and diabetes ( a major contributor to heart disease, stroke, and other
conditions). [ 5] Diabetes mellitus is the sixth leading cause of death for the older North
Carolina population in general, but like stroke, it is a more serious threat to the African-
American community, being the fourth highest cause of death in African Americans of all
ages in our state [ 19].
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 18
Five Leading Causes of Death among North Carolinians Age 65+
Rank Cause
1 Heart diseases
2 Cancer
3 Cerebrovascular diseases including stroke
4 Chronic lower respiratory diseases
5 Alzheimer’s disease
Source: NC Center for Health Statistics ( 2006). Leading Causes of
Death – 2005.
An important factor in health status is physical activity. A sedentary lifestyle is known to
increase a person’s risk of heart disease, diabetes, and other chronic conditions.
Unfortunately, in a multi- year study, North Carolinians age 65+ were ranked 48th among the
50 states in physical activity with nearly 40 percent of residents aged 65 and older reporting
that they did not engage in any physical activity in the past month. [ 21] The 2005 Behavioral
Risk Factor Surveillance System ( BRFSS) shows that nearly 66 percent of adults in that age
group do not participate in recommended levels of physical activity [ 22]. The BRFSS also
shows over one- third of people age 65+ say that their general health status is fair or poor.
 Grandparents Raising Grandchildren: According to the 2006 American Community there were
85,358 NC grandparents who reported that they had one or more grandchildren living with
them for whom they are responsible. This represents nearly half of all grandparents whose
grandchildren live with them and 1.6 percent of all North Carolina grandparents. Among
those grandparents responsible for their grandchildren, over 49 percent live in households in
which neither parent of the child is present. [ 23] According to AARP, 47 percent of NC
grandparents responsible for their grandchildren are African American; 2 percent are
Hispanic/ Latino; 2 percent are American Indian or Alaskan Native; and 47 percent are white
[ 24]. Given the relative sizes of these populations, it is clear that this is an even larger issue in
the African- American community than among other ethnic groups.[ 24]
 Veteran Status: Of the estimated 773,861 veterans living in North Carolina in 2007, over
263,755, or 34 percent, were age 65 and older. Another 260,811 ( 33 percent) were age 50 to
65, most of whom were Vietnam- era veterans. [ 25] The group of veterans from the Vietnam-era
contains proportionally more disabled members than survivors of earlier wars due to
quicker and more advanced medical treatment. [ 26] The Veterans Administration has
frequently written about the aging of the veterans as a major challenge to its health care
system in coming years.
Summary
In summary, North Carolina has a large, economically and ethnically diverse older population.
With this diversity come both special assets and special challenges. Even the most vulnerable older
adults often give as much to their communities as they receive. Nevertheless, we must be aware that
those who face disabilities, disparities of income and health care, and the responsibilities of caring
for grandchildren are more likely to need public services and supports. While meeting these
disparate needs of today’s older adults, our state is also witnessing the first minor steps of the
transition of the baby boomers into retirement ages. This will transform the age structure of the
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 19
state and bring a new generation of older adults with some of the same historic issues, but also new
attitudes, new challenges, new opportunities, and new resources.
Sources of Information
[ 1] Demographic Unit, Office of State Budget and Management ( 2006). " County Projected Age Groups: April 2010,
April 2020, and April 2030.
[ 2 ] NC Division of Aging and Adult Services ( 2003). The Aging of North Carolina: The 2003- 2007 North Carolina
Aging Services Plan
[ 3] Charles Longino ( 2003). States Ranked by the Net Number of Migrants Age 60+, 1985- 1990 and 1995- 2000.
[ 4] US Census Bureau ( 2008). 2006 American Community Survey Table B07001.
[ 5] NC Center for Health Statistics ( 2002). Healthy Life Expectancy in North Carolina, 1996- 2000.
[ 6] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File
stterr2006. xls: 2006- 50+ rank#”
[ 7] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File
stterr2006. xls: 2006- 50+ rank%”
[ 8] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ files
stterr2006. xls: 2006- 50+ x5,“ “ stterr2005. xls: 2006- 50+ x5- M” and “ stterr2006. xls: 2006- 50+ x5- F”
[ 9] Institute for Research on Women & Gender ( 2002). Difficult Dialogues Program Consensus Report: Aging in
the Twenty- first Century.
[ 10] US Census Bureau ( 2008). 2006 American Community Survey. Table B12002.
[ 11] US Social Security Administration ( 2008). Fast Facts & Figures about Social Security.
[ 12] US Administration on Aging ( 2008). Number of Persons 65+ by Race and Hispanic Origin- by State- 2006. File:
stterr2006. xls: 65+% xRace- HO
[ 13] US Census Bureau ( 2003). Census 2000 Summary File 3. Tables HCT2 and HCT24
[ 14] US Census Bureau ( 2003). Census 2000 Summary File 3. Table H71
[ 15] NC State Library ( 2003). Special tabulation from the Census 2000 data as requested by the NC Division of
Aging and Adult Services.
[ 16] US Census Bureau ( 2003). Census 2000 P5 ( Summary File 3).
[ 17] Making a Difference in Communities in the Sought ( MDC) ( 2002). State of the South 2002.
[ 18] US Census Bureau ( 2008). 2006 American Community Survey. Table B18001.
[ 19] NC Center for Health Statistics ( 2008). Leading Causes of Death- 2006
http:// www. schs. state. nc. us/ SCHS/ deaths/ lcd/ 2006/ pdf/ TblsA- F. pdf.
[ 20] Tri- State Stroke Network. ( 2006) Facts and Statistics: Stroke in the United States
http:// www. tristatestrokenetwork. org/ facts. html# buckle
[ 21] NGA Center for Best Practices ( 2004). Measuring the Years: State Aging Trends & Indicators.
[ 22] NC Department of Health and Human Services ( 2006). Behavioral Risk Factor Surveillance Calendar Year 2005
Results.
[ 23] US Census Bureau ( 2008). 2006 American Community Survey. Table B10050.
[ 24] AARP ( 2006). A State Fact Sheet for Grandparents and Other Relatives Raising Children.
[ 25] US Department of Veterans’ Affairs VetPop2006 Version 1.0 State and National Tables ( yearly projections)
http:// www1. va. gov/ vetdata/ docs/ 1l. xls
[ 26] US Department of Veterans’ Affairs ( 2002) VA History in Brief http:// webpages. charter. net/ wisconsinlegion-
7thdistrict/ VA_ History. htm# Vietnam_ War
Web Sites for Related Information
 NC Division of Aging and Adult Services ( http:// www. dhhs. state. nc. us/ aging/ demo. htm)
 Demographics Unit, NC Office of Budget and Management ( http:// demog. state. nc. us/)
 NC State Center for Health Statistics ( http:// www. schs. state. nc. us/ SCHS/)
 US Census Bureau ( http:// www. census. gov)
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 20
COMMISSION PROCEEDINGS
January 24, 2008
The North Carolina Study Commission on Aging met on Thursday, January 24, 2008, at 10: 00 a. m..
in Room 643 of the Legislative Office Building. Senator Vernon Malone presided. Following
introductions, Theresa Matula, Commission staff, presented an overview of the Commission's
responsibilities and statutory authority, the tentative meeting schedule for the interim, and the
Commission's budget. The Commission approved the budget.
Next the Commission heard from Shawn Parker, Commission staff, who presented a status report of
the Study Commission on Aging's recommendations to the Governor and the 2007 General
Assembly. A copy of the 2007 Recommendation Status Report is included in Appendix A. Ben
Popkin, Commission staff, then presented a document containing summaries of substantive
legislation related to older adults that was enacted during the 2007 Session. The Summary of
Substantive Legislation Related to Aging is included in Appendix A. Mr. Popkin was followed by
Melanie Bush of the Fiscal Research Division who provided an overview of 2007- 2009 legislative
budget actions and special provisions which are also provided in Appendix A.
The next presentation was an overview of older adults in North Carolina provided by Ms. Matula.
Her presentation focused on: who they are, how many there are, where they live, and what types of
programs and services are available for older adults in North Carolina. The presentation included
data on changes in the North Carolina population which depict the probability of significant growth
in the older adult population. The presentation included a brief summary of the range of services
provided in the State which include: Senior Games, Senior Centers, Adult Day Care and Adult Day
Health Care, State/ County Special Assistance, the State/ County Special Assistance In- Home
Program, the services provided by Home and Community Care Block Grant funds, the Community
Alternatives Program for Disabled Adults ( CAP/ DA), assisted living, Multiunit Assisted Housing
with Services, Adult Care Homes, Nursing Homes, and Continuing Care Retirement Communities.
Ms. Matula ended her presentation by mentioning additional information and resources including
the Area Agencies on Aging and various divisions within the Department of Health and Human
Services that serve older adults.
The last presentation for this meeting was a report required by S. L. 2007- 355, Section 2. In
response to the growth projections for the age 60+ population, the Division of Aging and Adult
Services, Department of Health and Human Services, was required to make recommendations on a
study to include all counties in North Carolina. The legislation required that the recommendation
specify the criteria that should be included in a study and an appropriate funding level for such a
study. Dennis Streets, Director, Division of Aging and Adult Services, reported that of the states
surveyed, 15 states indicated that they had undertaken a comprehensive statewide study in the past
five years. The reported costs ranged from $ 20,000 to $ 500,000 for the survey, but the states
emphasized that the important work does not end in a study. In fact, the study is just the beginning.
In response to these findings, the Division recommended the following: the State create a strategic
steering team; assess consumer needs, assets, and expectations; assess State and local awareness and
preparedness; conduct special studies; support State and local planning; and create an aging data
warehouse. The Division estimated a cost of $ 175,000 for the establishment of two positions to
support the work of the study, and $ 3,820,000 to fund the first year of the study. Of the $ 3,820,000,
$ 1,470,000 would be used to strengthen the capacity of Area Agencies on Aging ( AAA) for support
of regional and local planning ( including $ 270,000 to restore AAA State support reduced in 2001,
and $ 1,200,000 to add a position at each AAA to facilitate regional and community planning for
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 21
aging). The remaining $ 2,000,000 would provide $ 20,000 to each county to aid the work of citizen-driven
local aging leadership planning teams.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 1- 24- 08 Meeting.)
February 28, 2008
The North Carolina Study Commission on Aging met on February 28, 2008, at 1: 00 p. m. in Room
544 of the Legislative Office Building. Representative Jean Farmer- Butterfield was the presiding
Co- Chair.
During this meeting, the Commission heard brief presentations from 21 associations and
organizations that represent older adults. Each organization presented their legislative priorities and
or issues of concern to the Commission. For summary purposes, the issues mentioned with the
greatest frequency were: Increase Home and Community Care Block Grant Funds, Increase Senior
Center Funds, Provide Funding for Project C. A. R. E., Support for Adult Protective Services/ Enact
and Fund the Adult Protective Services Clearinghouse Model Pilot, and Increase Funds for New and
Existing Special Care Dental Programs ( Care in Underserved Areas, Long- term Care, Disabled
Seniors at Home). A Summary of Issues Most Frequently Mentioned by Organizations
Representing Older Adults is located in Appendix B.
The Commission also heard a report on Project C. A. R. E. ( Caregiver Alternatives to Running on
Empty). Steve Freedman, Service Operations Section Chief, Division of Aging and Adult Services,
Department of Health and Human Services; Dr. Charles Dickens, Speaker, Senior Tar Heel
Legislature; and Lisa Gwyther, Family Support Program Director, Duke Center for the Study of
Aging and Human Development; provided information about Project C. A. R. E. The goal of Project
C. A. R. E is to increase quality, access, choice, and use of respite and support services to low- income
rural and minority families caring for a person with dementia at home or within a hospital setting.
The program currently has three pilot sites that serve 14 counties and is administered through the
Division of Aging and Adult Services. The Division receives consultation and technical assistance
from the Duke Aging Center Family Support Program and is currently based within the
Mecklenburg County Department of Social Services, and two area offices of the Western Carolina
Alzheimer's Chapter. Project C. A. R. E. has received national recognition by numerous
organizations as a best practice model. Funding thus far has been provided by the U. S.
Administration on Aging's Alzheimer's Disease Demonstration Grants, leveraged through grants
provided by private foundations, and supplemented by Family Caregiver Support Programs.
However, grant funding is no longer an option for this particular program and State funding is
needed to continue the program. It was reported that the Department of Health and Human Services,
Division of Aging and Adult Services, would need $ 500,000 to sustain Project C. A. R. E. activities
in 14 western and piedmont counties.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 2- 28- 08 Meeting.)
March 6, 2008
The North Carolina Study Commission on Aging conducted the first of two public hearings this
interim on March 6, 2008, at 10: 00 a. m. in the Upper Coastal Plain business Development Center,
Wilson, North Carolina. Representative Jean Farmer- Butterfield was the presiding Co- Chair. At
this hearing, forty- two ( 42) people spoke to Commission members about a number of concerns
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 22
including: Increase Funding/ Continue Support for Senior Centers, Increase/ Continue Support for
Senior Games, Increase/ Continue Funding for Alzheimer's and Project C. A. R. E., Increase Funding
for Home and Community Care Block Grant ( HCCBG), Resolve Issues Related to Mentally Ill in
Long- Term Care Facilities, Increase Funding/ Support for Senior Friendly Housing. Appendix C
contains a summary of the public hearing comments.
March 28, 2008
The North Carolina Study Commission on Aging met on Friday, March 28, 2008, at 10: 00 a. m. in
Room 544 of the Legislative Office Building. Senator Vernon Malone was the presiding Co- Chair.
At this meeting, the Commission received a summary of the issues most frequently mentioned
during organization presentations and public hearings; heard a presentation from Dr. Victor
Marshall, Director, UNC Institute on Aging; and received reports on Respite Care, Mentally Ill in
Adult Care Homes, and a Reward System for Adult Care Homes with High Ratings.
Theresa Matula, Commission staff, presented summaries of the issues most frequently mentioned
on February 28, 2008, by organizations representing older adults, and a summary of the issues most
frequently mentioned during the public hearing on March 6, 2008. These summaries are located in
Appendix B and Appendix C.
Next, Victor Marshall, Director, UNC Institute on Aging, provided the Commission with
information about UNC Institute on Aging and the projects and programs that it supports. Dr.
Marshall also expressed: recommendations for a statewide aging study; the importance of
addressing public health issues of older adults; support for the Win A Step Up program; and
concerns related to aging workforce initiatives, specifically mentioning the Forum on North
Carolina's Aging Workforce, a two- day conference scheduled for September 23- 24, 2008.
In response to S. L. 2007- 39, Larry Nason, Chief, Facility and Community Care Section, Division of
Medical Assistance, Department of Health and Human Services ( DHHS), provided a report on
respite care. The report included information on the availability of respite care in North Carolina,
respite care in other states, and outlined four model programs. The respite care study group made
the following findings: separate statutory language for respite care is not needed; the existing
licensure and certification systems used by the Division of Health Service Regulation and the
Division of Aging and Adult Services allow for appropriate regulation of all levels and types of
respite care; consistent and predictable State funding for current respite care models is needed;
currently NC Medicaid only provides respite care as a billable service under its waiver programs
and as such, respite care is not provided as a " regular Medicaid" benefit under the State Plan. The
study group recommended that the North Carolina General Assembly provide an appropriation for
Project C. A. R. E., increase the State Adult Day Care Fund, and expand the Aging and Disability
Resource Connections to increase information and access on respite care services. The study group
also recommended that the Division of Aging and Adult Services study the place of group respite
programs in the long- term care continuum and assess the adequacy of service standards and
funding, and that the Division of Medical Assistance continue to study the potential of respite as a
State Plan Service.
S. L. 2007- 156 required the Department of Health and Human Services to study rules and
regulations regarding housing individuals with mental illness in the same facility vicinity as
individuals without mental illness, and to recommend staff training requirements for direct care
workers in adult care homes to provide appropriate care to residents with mental illness. Jackie
Sheppard, Assistant Secretary, Long Term Care and Family Services, DHHS, and Bonnie Morrell,
Best Practice & Community Innovations Team Leader, Division of Mental Health, Developmental
Disabilities and Substance Abuse Services, DHHS presented the report. The report includes: an
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 23
overview of how eight other states handle placement of mentally ill individuals in assisted
living/ adult care home facilities; information on the limited use of adult care home special care units
for residents with mental health disorders; revisions to staffing rules; recommendations and cost
figures on the screening, assessment, and the provision of services to mentally ill individuals in
adult care homes; and proposed training recommendations and associated costs.
The report recommended six items at a cost of $ 20.9 million dollars in recurring funds and
approximately $ 1.8 million in nonrecurring funds. The recommended system includes: developing
and automating a comprehensive assessment and care plan system for residents in adult care homes;
expanding required minimum training levels; requiring Preadmission Screening and Annual
Resident Review ( PASARR) Level II assessments of adult care home residents or potential
residents who are referred for this level of evaluation; determination of specialized mental health
care needs based on PASARR Level II assessments; development of additional capacity to serve
residents in adult care homes who need mental health services; and the implementation of a pilot to
develop a residential program for people with mental illness currently in adult care homes but who
require a different residential setting. The report included a flow chart depicting the steps for an
individual with a history of mental illness. The first step included screening adult care home
residents using the Medicaid Uniform Screening Tool ( MUST) which would identify the need for a
face to face mental health evaluation. If the mental health assessment was needed, a professional
assessment would be given using PASARR Level II. For those individuals that need specialized
mental health services, care would be provided either in a mental health residential setting, or the
person would live in the adult care home and mental health care would be provided by community
mental health services. The key to implementation of most, if not all, of these changes seem to
hinge on screening and assessment of adult care home residents to determine individual needs.
The final report for this meeting presented by Jeff Horton, Chief Operating Officer, Division of
Health Service Regulation, DHHS, was on a reward system for adult care homes with high ratings.
The report, developed pursuant to S. L. 2007- 544, Section 3d., recommended a system modeled after
a nursing home program that has been successful in making facilities better places for residents to
live and better places for employees to work. The report recommends that adult care homes
achieving a four star rating ( 100 points or higher on two consecutive annual surveys by the Division
of Health Service Regulation), under the Star Rating System, are deemed to have received a high
rating and are therefore eligible for the reward.
The nursing home program is funded with civil monetary penalties. However, under North
Carolina law, fines collected from adult care homes are transferred to local education agencies. As
such the General Assembly would have to appropriate funds for the reward system for adult care
homes. The Star Rating System is effective January 2009, thus January 2010 would be the first time
facilities might be eligible for rewards, assuming a score of 100 points during the 2009 cycle and
during the 2010 cycle.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 3- 28- 08 Meeting.)
April 10, 2008
The North Carolina Study Commission on Aging met at 10: 00 a. m. on April 10, 2008, in Room 421
of the Legislative Office Building. Representative Jean Farmer- Butterfield presided. Presentation
topics included: criminal background checks for nursing home administrators, guardianship issues,
hearing challenges for older adults, and a report on the aging service levels and needs study.
Jane Baker, Executive Director, North Carolina State Board of Examiners for Nursing Home
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 24
Administrators, and Steve Fleming, Chair, North Carolina State Board of Examiners for Nursing
Home Administrators, presented information on a statutory amendment that would grant the Board
the authority to conduct criminal history record checks. Information presented to the Commission
indicated that the Board desires the authority to require criminal history record checks on:
applicants from North Carolina, applicants seeking licensure by reciprocity, and persons renewing
their licenses.
Pamela W. Best, Deputy Legal Counsel, Administrative Office of the Courts, gave the Commission
an overview of guardianship in North Carolina. Her presentation focused on the determination of
incompetency, the appointment of a guardian, and the powers and responsibilities of guardians.
Representative Melanie Goodwin followed the presentation with information on two
recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly. The Study Committee on State Guardianship Laws found that guardians
currently have the authority to sell up to $ 1,500 worth of personal property without a court order in
order to meet the monetary needs of the ward, but determined that this amount was outdated and
insufficient, and recommended that the total amount of personal property allowed to be sold without
a court order be increased to $ 15,000. In response to the findings, House Bill 794 was introduced
but did not crossover to the Senate and is not eligible for consideration during the 2008 Session.
During the course of their work, the Committee on State Guardianship Laws also found it
unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an
individual who has been declared incompetent. In response, the Committee recommended that the
Division of Motor Vehicles be authorized to not automatically revoke the drivers license of an
incompetent if the clerk of superior court recommends the incompetent be allowed to retain the
drivers license. House Bill 796 was introduced during the 2007 Session, but did not crossover to the
Senate and is not eligible for consideration during the 2008 Session.
Dennis Streets, Director, Division of Aging and Adult Services, Department of Health and Human
Services presented a report in response to S. L. 2007- 355, Section 1. The law directed the Division
of Aging and Adult Services, to work with the Division of Health Service Regulation; Division of
Medical Assistance; Division of Public Health; and the Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services; to study programs and services for older adults in
Brunswick, Buncombe, Gaston, Henderson, Moore, and New Hanover Counties which currently
have, or are projected by 2030 to have, the largest numbers of individuals age 60+ when compared
to individuals age 17 and younger. In conducting the study, the Division was directed to utilize
existing data and resources, to include the Area Agencies on Aging serving each county studied,
and to report to the Study Commission on Aging and to the board of county commissioners of each
county studied. The study included the following elements: a profile of the current older adult
population; a profile of the projected growth for the older adult population; an assessment of the
anticipated impact on programs and services that address the needs of the older adult population;
identification of programs and services that are currently in place; identification of programs and
services that are needed to meet the growth projections; current funding sources for programs and
services serving the older adult population; anticipated funding needs for programs and services
serving the older adult population; and a delineation of the programs and services that are shared or
offered jointly with another county. Mr. Streets outlined the approach taken, the products provided
to each of the six counties, and highlighted particular findings for the Commission. The
presentation also listed the top areas of concern identified by the survey.
Next, Theresa Matula, Commission staff, presented draft recommendations for the Commission's
consideration. The draft recommendations represented a range of programs and issues heard by the
Commission during the interim. Ms. Matula presented 13 recommendations with background
information for each and explained that once the Commission approved recommendations, they
would be compiled in a report, including bill drafts as applicable, for the Governor and the 2008
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 25
General Assembly. During this meeting, the Commission approved 13 recommendations contained
in this report and agreed to consider several additional recommendations presented by a
Commission member at the final meeting on May 12, 2008.
For a period of time, the agenda and handouts for this meeting are available on the internet at:
http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08
Interim Committee Meetings, 4- 10- 08 Meeting.)
April 24, 2008
The North Carolina Study Commission on Aging conducted a second public hearing this interim at
10: 00 a. m. on April 24, 2008 at the Town Hall in Jamestown, North Carolina. The Commission
heard from fifty- two ( 52) individuals during this hearing. The issues mentioned with greatest
frequency during the Jamestown hearing were: Funding for Project C. A. R. E., Continued Support
for the Star Rating System, Support for the Adult Protective Services Pilot Program, Increased
Funding for the Home and Community Care Block Grant ( HCCBG), Support for Access Dental
Care and Mobile Dental Units, Support for Adult Day Care, and Support for Senior Centers.
Appendix C contains a summary of the public hearings and information on which topics were
mentioned most frequently at both hearings.
May 12, 2008
The North Carolina Study Commission on Aging met on May 12, 2008, at 10: 00 a. m. in Room 544
of the Legislative Office Building. Senator Malone was the presiding Co- Chair. During the
meeting, staff reviewed the Commission's draft report to the Governor and the 2008 Regular
Session of the 2007 General Assembly. The Commission voted to approve the draft report as
amended.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 26
COMMISSION RECOMMENDATIONS
The North Carolina Study Commission on Aging makes the recommendations presented in this
report to the Governor and the 2008 Session of the 2007 General Assembly. Each recommendation
is followed by background information, and corresponding legislative proposals, if applicable,
appear Appendix D of this report.
Recommendation 1: Senior Center Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent
that it shall become part of the continuation budget.
Background 1: Senior Center Funds
During 2007, the Study Commission on Aging recommended that the General Assembly
appropriate an additional $ 500,000 for the 2007- 2008 fiscal year ( FY) and $ 500,000 for the 2008-
2009 FY, to the Senior Center General Purpose Fund to provide additional support for Senior
Centers. The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)
contained $ 200,000 in non- recurring funding for the 2007- 2008 FY for the Senior Center General
Purpose Fund.
Increasing senior center funds generally, or specifically making the 2007- 2008 FY increase
recurring, were the most frequently mentioned items during the Wilson public hearing on March 6,
2008 and was mentioned often during the public hearing in Jamestown. Increasing senior center
funding was the second most frequently mentioned item during the February 28, presentations to
the Commission by organizations representing older adults. It was listed as a priority by the
Governor's Advisory Council on Aging, and the Senior Tar Heel Legislature, among others.
Services offered through senior centers include: health and wellness programs, arts and humanities,
intergenerational programs, employment assistance, transportation services, and volunteer
opportunities. The National Institute of Senior Centers defines a senior center as a, " place where
older adults come together for services and activities that reflect their experience and skills,
respond to their diverse needs and interests, enhance their dignity, support their independence, and
encourage their involvement in and with the center and the community."
The Division of Aging and Adult Services reports that there are currently 164 recognized senior
centers in North Carolina. Primary sources of funding are: 1) the Home and Community Care
Block Grant, 2) local government, and 3) the State's Senior Center General Purpose and Outreach
Funds.
The State supports senior centers by funding the Senior Center Outreach and General Purpose
funds. The Senior Center General Purpose Fund was initiated in 1997 and is used for any purpose
that supports operations or development including: equipment purchases/ repairs, building
maintenance, supplies, administrative costs, activities, and construction.
The State appropriation for the 2007- 2008 FY is $ 1,465,316 for the Senior Center General Purpose
Fund and $ 100,000 for Senior Center Outreach. An additional 25% local cash or in- kind match is
required for receipt of State funds. For FY 2007- 08, Senior Centers received a $ 200,000 increase
in General Purpose funds on a non- recurring basis.
Senior Centers receive funding in " shares" – one share for Uncertified Centers ( 108 centers), two
shares for Centers of Merit ( 8 centers), and three shares for Centers of Excellence ( 48 centers). The
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 27
State allocation distribution for the 2007- 2008 FY is: $ 5,467 for Uncertified Centers, $ 10,936 for
Centers of Merit, and $ 16,404 for Centers of Excellence.
The Study Commission on Aging recognizes the importance of senior centers and supports
enactment of 2007- SHz- 23 to provide additional funding for the 2008- 2009 fiscal year.
Recommendation 2: Additional HCCBG Funds
The Study Commission on Aging recommends that the General Assembly appropriate an additional
$ 2,500,000, to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the
Home and Community Care Block Grant ( HCCBG).
Background 2: Additional HCCBG Funds
Increasing Home and Community Care Block Grant ( HCCBG) Funds was the issue mentioned
most frequently during the February 28, presentations to the Commission by organizations
representing older adults, the second most frequently mentioned item at the public hearing in
Wilson and one of the most frequently mentioned items at the Jamestown public hearing. Eight of
the 21 organizations that spoke on February 28, supported increasing HCCBG Funds including the
Governor's Advisory Council on Aging and the Senior Tar Heel Legislature.
In 2007, the Study Commission on Aging recommended the General Assembly appropriate an
additional $ 5,000,000 to the Department of Health and Human Services for the 2007- 2008 fiscal
year and $ 5,000,000 for the 2008- 2009 fiscal year for the Home and Community Care Block Grant
( HCCBG). The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)
contained $ 536,000 in recurring funding for the 2007- 2008 fiscal year and the 2008- 2009 fiscal
year.
The HCCBG, established by G. S. 143B- 181.1( a)( 11), is the consolidation of several funding
sources ( i. e., the Older Americans Act, the Social Services Block Grant in support of respite care,
portions of the State In- Home and Adult Day Care funds, and other relevant State appropriations).
The HCCBG includes federal funds, State funds, local funds, and a consumer contribution
component. It gives counties discretion, flexibility, and authority in determining services, service
levels, and service providers, and streamlines and simplifies the administration of services.
With input from older adults, county commissioners approve an annual funding plan that defines
the services to be provided, the funding levels for these services, and the community service
agencies to provide the services. Counties can select from among 18 eligible services including:
Adult Day Care, Adult Day Health Care, Care Management, Congregate Nutrition, Group Respite,
Health Promotion and Disease Prevention, Health Screening, Home Delivered Meals, Housing and
Home Improvement, Information and Assistance, In- Home Aide, Institutional Respite Care, Mental
Health Counseling, Senior Center Operations, Senior Companion, Skilled Home ( Health) Care,
Transportation, and Volunteer Program Development. Counties decide which services to provide,
however congregate nutrition and home- delivered meals are provided in almost every county under
the HCCBG.
Any person age 60 and older is eligible for services under the HCCBG. Although, the HCCBG
program places an emphasis on reaching those most in need of services. The Older Americans Act
( OAA), a funding source in the HCCBG, gives priority to serving the " socially and economically
needy" and focuses particular attention on the low income minority elderly and on older individuals
residing in rural areas. Additionally, the OAA calls for reaching out to older individuals with severe
disabilities, limited English- speaking ability, and Alzheimer's disease or related disorders and
caregivers of these individuals.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 28
The focus of the HCCBG is to support the frail elderly that are cared for at home; improve and
maintain the physical and mental health of older adults; assist older adults and their caregivers with
accessing services and information; provide relief to family caregivers so that they can continue
their caregiving; and allow older adults to remain actively engaged with their communities.
The Study Commission on Aging recognizes the importance of the services provided through the
Home and Community Care Block Grant and supports increased funding through enactment of
2007- SHz- 24.
Recommendation 3: Funds for Project C. A. R. E.
The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000, to
the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty)
which provides support to individuals with dementia and their caregivers.
Background 3: Support Project C. A. R. E.
Providing funding for Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) was the
most frequently mentioned item during the public hearing in Jamestown and the third most
frequently mentioned item during the presentations to the Commission by organizations
representing older adults. The Governor's Advisory Council and the Senior Tar Heel Legislature
both mentioned this item as a legislative priority for their organizations.
In 2007, the Study Commission on Aging recommended that the General Assembly appropriate
$ 500,000 to the Department of Health and Human Services, Division of Aging and Adult Services,
for the 2007- 2008 fiscal year, and $ 500,000 for the 2008- 2009 fiscal year, to fund Project C. A. R. E.
which provides support to individuals with dementia and their caregivers. In response to this
recommendation, SB 165 and HB 96 were introduced during the 2007 Session and referred to
Appropriation Committees, but did not receive further action.
A statistical abstract, " 2008 Alzheimer's Disease Facts & Figures," of US data on Alzheimer's
disease published by the Alzheimer's Association recently reported that it is anticipated that
between 2000 and 2010, North Carolina will experience a 31% increase in the number of people
age 65+ with Alzheimer's disease. According to the report, in 2007, there were 311,578
Alzheimer/ dementia caregivers providing 268,953,971 hours of unpaid care per year with an
economic value of $ 2,845,533,016. The report notes that in 2005, Alzheimer's disease was the
seventh- leading cause of death for people of all ages and the fifth- leading cause of death for people
age 65 and over.
The Commission heard a presentation on Project C. A. R. E. during the meeting on February 28,
2008. The goal of Project C. A. R. E. is to increase quality, access, choice, and use of respite and
support services to low- income rural and minority families caring for a person with dementia at
home or within a hospital setting. The program is administered through the Division of Aging and
Adult Services with assistance from the Duke Aging Center Family Support Program. A Project
C. A. R. E. in- home visit: assesses the family care environment; identifies the needs and preferences
of both the caregiver and the person with dementia; facilitates discussion and mutual understanding
among family members; connects the family with community resources; and ensures the provision
of quality respite care and support services.
Project C. A. R. E. began with the Alzheimer's Association, Western Chapter, in 2001. Funding thus
far has been provided by the U. S. Administration on Aging's Alzheimer's Disease Demonstration
Grants, leveraged through grants provided by private foundations, and supplemented by Family
Caregiver Support Programs. Initially, the program served six ( 6) counties. There are currently
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 29
three ( 3) Project C. A. R. E. pilot sites set up to serve 14 counties: Charlotte ( Mecklenburg County);
Winston- Salem ( Forsyth, Surry, and Stokes); and Asheville ( Polk, Henderson, Transylvania,
Rutherford, Madison, McDowell, Buncombe, Haywood, Jackson, and Swain). The program
received national recognition as a model and best practice in 2004 and 2005. Grant funding is no
longer an option for this particular program and State funding is needed to continue the program.
The total budget for the program is $ 433,333, which includes a 25% local match. The federal
funding portion of that total is $ 325,000 and will end June 30, 2008. The Department of Health
and Human Services, Division of Aging and Adult Services, needs $ 500,000 to sustain Project
C. A. R. E. activities in 14 western and piedmont counties. If $ 500,000 is appropriated, there would
be a 25% matching requirement in the amount of $ 166,666, for total funds amounting to $ 666,666.
It is anticipated that the level of local interest and current activity in services in the 14- county area
will yield sufficient funding to meet matching requirements. A possible advantage to this
appropriation is that if the State funds the existing program infrastructure and service capacity,
North Carolina may be eligible to receive grants to replicate Project C. A. R. E. in Eastern North
Carolina, moving toward the ultimate goal of statewide expansion.
The Study Commission on Aging appreciates caregivers, recognizes the importance of respite,
supports State funding for Project C. A. R. E., and therefore encourages enactment of 2007- SHz- 25.
Recommendation 4: Adult Protective Services Pilot Program
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087,
to the Department of Health and Human Services, Division of Aging and Adult Services, for the
2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed
changes to the adult protective services statutes and to report to the Study Commission on Aging on
the evaluation of the pilot by March 1, 2010.
Background 4: Adult Protective Services Pilot Program
Support for Adult Protective Services/ Enact and Fund the Adult Protective Services ( APS)
Clearinghouse Model Pilot was the fourth most frequently mentioned item during the organization
presentations on February 28, and was among the most frequently mentioned items during the
public hearings in Wilson and Jamestown.
In 2007, the Study Commission on Aging recommended that the General Assembly appropriate
$ 1,492,000 to the Department of Health and Human Services, Division of Aging and Adult
Services, for the 2007- 2008 fiscal year and $ 1,930,000 for the 2008- 2009 fiscal year to enact a pilot
program to assess proposed changes to the adult protective services statutes and to report on the
evaluation of the pilot by March 1, 2009. In response to this recommendation, HB 198 and SB 108
were introduced and referred to Appropriations Committees, but no further action was taken.
S. L. 2005- 23 directed the Adult Protective Services ( APS) Task Force to collaborate with
stakeholders and others interested in improving APS and to report those findings to the Study
Commission on Aging and the House Study Committee on Guardianship Laws. The APS
Clearinghouse Model: NC's System of Protection, is the product of a collaborative effort among the
Division of Aging and Adult Services, the NC Association of County Directors of Social Services,
representatives from the Attorney General's office, stakeholders, and other interested parties. The
goals of the APS Clearinghouse Model are to: increase North Carolina's ability to reach out to
citizens to offer voluntary services; enable North Carolina to respond to high risk situations before
harm occurs and provide the opportunity to assist older adults who are victimized, but not
incapacitated; allow APS to intervene before the adult's health deteriorates to life- threatening
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 30
levels; and allow APS to provide information and services to a greater number of adults.
Exploring feasibility of the APS Clearinghouse Model requires implementation of a pilot. The
pilot will require funding for staff in county departments of social services to carry out the pilot,
and funding for three ( 3) staff positions in the Division of Aging and Adult Services ( DAAS) to
plan and conduct the pilot. The total budget for the APS Pilot in the 2008- 2009 fiscal year is
$ 1,497,087, broken down as follows: $ 1,212,805 for county staff ( 24.103 FTEs for 9- months),
$ 159,532 for DAAS staff ( 3.0 FTEs for 9- months), $ 18,000 for public education, $ 6,750 for
essential services, and $ 100,000 for evaluation of the pilot. An additional $ 1,930,107 is needed for
the 2009- 2010 fiscal year which would be utilized for the following: $ 1,617,308 for county staff,
$ 188,049 for DAAS staff, $ 18,000 for public education, and $ 6,750 for essential services, and
$ 100,000 for evaluation of the pilot.
The Study Commission on Aging realizes the vital importance of safeguarding our older adults and
supports the enactment of 2007- SHz- 26.
Recommendation 5: Statewide Aging Study
The Study Commission on Aging recommends support for a comprehensive, five- year statewide
study of the older adult population and the State's readiness to respond to the coming wave of older
adults by recommending that the General Assembly take the following steps: establish an
appointment process for a steering committee; appropriate $ 175,000 to the Department of Health
and Human Services, Division of Aging and Adult Services, for the establishment of two positions
to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult
Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the
Department of Health and Human Services, Division of Aging and Adult Services, to make annual
reports to the General Assembly on the status of the study.
Background 5: Statewide Aging Study
S. L. 2007- 355, Section 1, required several Divisions within the Department of Health and Human
Services to study programs and services for older adults in Brunswick, Buncombe, Gaston,
Henderson, Moore, and New Hanover Counties. These counties currently have, or are projected by
2030 to have, the largest numbers of individuals age 60+ when compared to individuals age 17 and
younger.
Since growth projections for the age 60+ population are anticipated to increase overall in North
Carolina, S. L. 2007- 355, Section 2, required the Division of Aging and Adult Services to make a
recommendation on a study to include all counties in North Carolina. The Division was required to
evaluate similar studies conducted by other states and to make recommendations on the criteria that
should be included and an appropriate funding level for a study to include all North Carolina
counties. On January 24, 2008, the Division made a report to the Commission on a statewide
study.
The report recommends the establishment of a steering committee to: oversee the design and
implementation of a consumer needs assessment and an expectations assessment; oversee the
design and implementation of a State and local awareness and preparedness assessment; identify
the need for and to obtain additional studies to supplement the information needed for
comprehensive planning; produce reports for the Governor and General Assembly to guide policy
and program development based on the findings of the assessments and studies; and to identify
action needed to ready North Carolina for its growing older adult population. The Committee
would be appointed by the General Assembly and the Governor.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 31
The report recommends two positions to support the steering committee: a Human Services
Planner/ Evaluator IV ( pay grade 74), and an Administrative Assistant III ( pay grade 67). The cost
for these positions is $ 175,000.
Use of a consumer survey is recommended in years one and four of the statewide study, for design,
implementation, analysis, and reporting associated with conducting a survey of consumer needs,
assets, and expectations. The anticipated cost is $ 200,000 for the 2008- 2009 fiscal year and
$ 175,000 for the 2011- 2012 fiscal year. ( It is anticipated that there would be some savings in
survey design the second year.) The report recommends funds for design, implementation, analysis
and reporting associated with conducting a survey of state and local governments at a cost of
$ 75,000 in the 2008- 2009 fiscal year, 2010- 2011 fiscal year, and 2012- 2013 fiscal year.
Additionally, the report recommends $ 75,000 per year to secure the services of consultants to
conduct special studies and otherwise support the work of the steering committee.
With regard to support for program services, the report recommends:
 $ 1,470,000 per year to strengthen the capacity of Area Agencies on Aging ( AAA) for
support of regional and local planning ( this includes restoring the $ 270,000 in recurring
AAA State support reduced in 2001, and adding a position at each AAA to facilitate
regional and community planning for aging at a cost of $ 1,200,000 million per year ( which
would total $ 1.6 million with a 25% match participation rate)).
 Awarding $ 20,000 to each county to aid the work of citizen- driven local aging leadership
planning teams for a total cost of $ 2,000,000 per year.
The Study Commission on Aging believes that it is necessary for the State to make preparations
now to care for the anticipated increase in the older adult population and supports a statewide study
of the State's readiness to respond through the enactment of 2007- SHz- 29.
Recommendation 6: Adult Care Home Residents
Recommendation 6a: Adult Care Home Admission Screening Process
The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for
mental health and developmental disability conditions as part of the adult care home admission
process. The process shall duplicate the nursing facility admission process and shall consist of an
automated screening tool and where indicated a face- to- face assessment by a mental health or
developmental disabilities professional. The Division of Medical Assistance shall report on the
design, development, and piloting of the screening process for mental health and developmental
disability conditions as part of the adult care home admission process on or before October 15,
2008.
Recommendation 6b: Transitional Residential Treatment Program Pilot Sites
The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental
Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically
diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.
Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care
Workers in Adult Care Homes
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Health Service Regulation, Division of Medical
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 32
Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse
Services to work with adult care home providers to build on recent studies to determine the most
appropriate and cost effective way to provide training on the care of individuals with mental illness
to direct care workers in adult care homes by tailoring the training to resident assessment results
and utilizing web- based formats as appropriate, and to provide an interim report to the Study
Commission on Aging by November 1, 2008, and a final report by November 1, 2009.
Recommendation 6d. Assessment and Service Plan Development for Adult Care
Home Residents
The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000,
for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of
Medical Assistance to support assessment and service plan development for adult care home
residents and to provide an interim report by November 1, 2008, and a final report by November 1,
2009.
Background 6: Adult Care Home Residents
S. L. 2007- 156 ( SB 164) directed the Department of Health and Human Services to study rules and
regulations regarding housing individuals with mental illness in the same facility vicinity as
individuals without mental illness, and to recommend staff training requirements for direct care
workers in adult care homes to provide appropriate care to residents with mental illness.
On March 28, 2008, the Commission heard a presentation of the report prepared in response to S. L.
2007- 156. The report provides an overview of how eight ( 8) other states handle placement of
mentally ill individuals in assisted living/ adult care home facilities; information on the limited use
of adult care home special care units for residents with mental health disorders; revisions to staffing
rules; recommendations and cost figures on the screening, assessment, and the provision of services
to mentally ill individuals in adult care homes; and proposed training recommendations and
associated costs.
The report indicates the percentage of residents with mental illness as compared to the total number
of residents. The report indicates that family care homes ( facilities with six or fewer beds) had in
the following years, the percentage of adults with mental illness: 2002 = 38.1%, 2003 = 52.7%,
2004 = 60%, 2005 = 44.4%, 2006 = 45.5%, and 2007 = 46.3%. Adult care homes ( seven or greater
beds) had in the following years, the percentage of adults with mental illness: 2002 = 18.2%, 2003
= 27.7%, 2004 = 30.8%, 2005 = 20.2%, 2006 = 20.2%, and 2007 = 19%.
The report provides a process to assess and provide care to meet the needs of adult care home
residents, especially mentally ill residents. The key first step to providing care is to assess the type
of care needed through the implementation of screening and assessment programs. Currently a
physician designates the appropriate level of care for a potential resident using the FL- 2 form. The
Department has developed the Medicaid Uniform Screening Tool ( MUST, Level I) which is
anticipated to replace the FL- 2 form in September 2008. If the MUST screening determines that
additional mental health assessment is needed, the individual would be referred for the Pre-
Admission Screening and Resident Review ( PASARR), Level 2 Assessment. The PASARR Level
2 Assessment will determine whether the individual needs a specialized mental health service.
According to the report, if a PASARR Level 2 assessment indicates that specialized mental health
services are needed, the Division of Mental Health, Developmental Disabilities and Substance
Abuse Services ( DMH/ DD/ SAS) will be notified and service needs will be communicated to the
Local Management Entity ( LME). The LME will then contact the individual. The Department
estimates the PASARR Level II costs for fiscal year 2008- 2009 as $ 1,764,000 and $ 281,840 on a
recurring basis.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 33
The report outlines the need for $ 580,000 to develop and automate a comprehensive assessment
and care plan system for residents in adult care homes. This assessment, care planning, and
training system is being developed through VieBridge, Inc. with funding from the North Carolina
Association Long Term Care Facilities ( NCALTCF). The NCALTCF and the Department of
Health and Human Services, Divisions of Health Service Regulation and Medical Assistance, have
worked in a collaborative arrangement on this system. The funding would be used to support the
assessment and care planning system for adult care home residents and statewide implementation is
anticipated January 1, 2009.
The report provides information on development of Transitional Residential Treatment Programs.
This new type of 6- bed residential facility would provide 24- hour residential treatment and
rehabilitation of adults who have a pattern of difficult behaviors related to mental illness which
exceed the capabilities of traditional community residential settings. The Department would like to
pilot three ( 3) sites at an annual cost of $ 378,056/ site and anticipates being able to utilize funds
beginning in January 2009. This would require an appropriation of $ 567,084 for FY 2008- 2009
($ 378,056 x 3 = $ 1,134,168 / 2= $ 567,084.)
The report outlines three layers of training: Two ( 2) hours of Basic Orientation training for all
facility staff; Twelve ( 12) hours of Specialized ( Phase Two) Training for aides and direct
supervisors of all facilities serving one or more persons with mental illness; and four ( 4) hours of
Annual Training for aides and direct supervisors of all facilities serving one or more persons with
mental illness. An annual cost of $ 4,500,00 was provided for the training.
The report also suggests the following to take place after screening and assessment: $ 334,000 for
PASAAR Level II assessments to determine specialized mental health care needs and $ 14,860,000
to develop capacity to care for adult care home residents needing mental health services.
After the April 10, 2008 meeting and approval of the Commission's initial recommendation on this
topic, the Department of Health and Human Services decided to scale back implementation of the
Medicaid Uniform Screening Tool ( MUST), which was the basis for the recommendation to
develop and implement PASARR, Level II screening prior to adult care home admission. Although
MUST will not be ready for Statewide implementation, the Department anticipates that it will have
a screening tool in place in by fall 2008, and that this initial screening tool will be able to identify
those residents that will need a face- to- face mental health evaluation. Therefore, the Commission is
recommending that the General Assembly appropriate $ 1,764,000 for FY 08- 09 to the Department
of Health and Human Services, Division of Medical Assistance, to design, develop, and implement
on a pilot basis, a screening process, for mental health and developmental disability conditions as
part of the adult care home admission process. It is anticipated that the process will duplicate the
nursing facility admission process and will consist of an automated screening tool and where
indicated a follow- up face- to- face assessment by a Mental Health or Developmental Disabilities
professional.
In it's report to the Commission, the Department provided that after a mental health assessment is
completed, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
( DMH/ DD/ SAS) staff would make the final determination about whether the individual needed
specialized mental health screening, contact the LME to arrange for services, and follow- up to be
sure services are provided. The report requested $ 334,000 for five additional positions to provide
this function. For the pilot implementation of the mental health evaluation contained in this
recommendation, it is anticipated that DMH/ DD/ SAS will absorb this function.
This revised recommendation also requires the Division of Medical Assistance, Division of Health
Service Regulation, and DMH/ DD/ SAS to report on the design, development, and piloting of the
screening process for mental health and developmental disability conditions as part of the adult care
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 34
home admission process in an interim report by October 15, 2008, with a final report due October
15, 2009. The Division's report must contain findings and recommendations to include: results on
how many individuals were received initial screening prior to admission, how many needed an
additional mental health evaluation, and how many of those screened were admitted to an adult care
home; a process chart of the screening for adult care home admissions, who performs the screening,
and turnaround times for each step in the process; whether there are delays due to pre- admission
screening and how these are handled; whether the process should be expanded to all adult care
home admissions on a Statewide basis; whether statutory or policy changes are needed for
Statewide implementation; and costs associated with Statewide implementation.
In an effort to begin to address the issue of mixed populations in adult care homes, the Study
Commission on Aging supports enactment of 2007- SHz- 31.
Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings
The Study Commission on Aging expresses support for the creation of a reward system for adult
care homes that achieve high ratings and at the appropriate time, the Commission anticipates
supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).
Background 7: Support for a Reward System for Adult Care Homes with High Ratings
In response to recommendations from the Study Commission on Aging, S. L. 2007- 544 was enacted
and Section 3 contained provisions related to a rating system for adult care homes. Section 3( d)
required the Department of Health and Human Services to study the structure and cost of a system
to reward adult care homes that receive high ratings and to report findings and recommendations to
the Study Commission on Aging no later than March 1, 2008.
On March 28, 2008, the Commission heard the report on the structure and cost of a system to
reward adult care homes receiving high ratings. The report recommended a system modeled after
the grant program for nursing homes that is funded on civil monetary penalties. According to the
report, the program for nursing homes, which was started in 1996, has been a highly successful,
cooperative effort among regulators, providers, advocates, and others to make facilities better
places for residents to live and better places for employees to work. Under North Carolina law,
fines collected from adult care homes are transferred to local education agencies and therefore, the
General Assembly would have to appropriate funds for the reward system for adult care homes.
The report recommends that an adult care homes that achieves a 4 Star Rating ( 100 points or higher
on two consecutive annual surveys by the Division of Health Service Regulation) would receive a
high rating and therefore eligible for the reward. The Star Rating System is effective January 2009,
thus January 2010 would be the first time facilities might be eligible for rewards, assuming a score
of 100 points during the 2009 cycle and during the 2010 cycle. The Department also requested an
administrative officer position at a cost of $ 50,000, to coordinate and administer the grants in
response to decisions made by a Grant Committee, which consists of adult care home stakeholders
including provider representatives, advocates, Division of Health Service Regulation staff, and
others. As such, the estimated costs for this reward system are $ 300,000 for FY 2009- 2010
($ 250,000 for rewards and $ 50,000 for the position) and $ 550,000 for the 2010- 2011 fiscal year.
The Study Commission on Aging supports rewarding adult care homes with high ratings.
Recommendation 8: Support for Respite Care
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services, Division of Aging and Adult Services, to study the adequacy of
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 35
service standards and funding for group respite services, and whether opportunities exist to
streamline and enhance the provision of respite services; direct the Division of Medical Assistance,
Department of Health and Human Services, to study the feasibility of providing respite care as a
State Plan Service, and provide a report on both issues to the Commission on Aging by November
1, 2009.
Background 8: Support for Respite Care
S. L. 2007- 39 directed the Department of Health and Human Services to study the availability and
delivery of respite care. On March 28, 2008, the Commission heard a presentation on the
Department's report. The Department reported that there is a need for respite care and that the
provision of respite care is important for the State from an economic perspective. The report
provided an overview of the various respite programs available in North Carolina as well as
information on programs in other states. One of the issues noted was the fragmentation of services
both in North Carolina and other states. The fragmentation is due to varying eligibility criteria,
target client populations, regulatory requirements, programs, and funding streams. The report
suggested that, " While the fragmentation makes respite care more difficult to administer, it does
provide for the needs of a diverse population." Four model programs for respite care are defined in
the report: Project C. A. R. E, Jackson County Family Resource Center, A Small Miracle, Inc. and
Senior Companion Respite Program.
The report indicated that the study group did not see a need for separate statutory language for
respite care, but believed that consistent state funding was needed under the existing systems. The
study group agreed that respite care delivery could be enhanced if Medicaid included respite as a
State Plan Service. The report stated that, a respite service, defined as an Optional Medicaid State
Plan Service, should be offered to all who qualify, regardless of where the recipient lives or the
recipient's diagnosis, and should be based on needs. Further, the report suggested the State may
limit the definition, duration, and scope, and that an assessment of caregiver capability was integral
to the process. The report indicated that the Division of Medical Assistance would pursue an
internal review of this option. Additionally, the report supported study by the Division of Aging
and Adult Services, Department of Health and Human Services, on the place of group respite
programs in the long- term care continuum and the adequacy of service standards and funding.
The Commission supports caregivers and the provision of respite services and therefore
recommends the enactment of 2007- SQz- 11 to require the Department of Health and Human
Services continue to study ways to make respite care more accessible.
Recommendation 9: Study Older Adult Hearing Loss
The Study Commission on Aging recommends that the General Assembly direct the Department of
Health and Human Services to study the current and anticipated impact of hearing loss on North
Carolina's older adult population and the availability and access to qualified professionals for
treatment and hearing aid purchase assistance for low income individuals; to develop an inventory
of the technology available to assist individuals; and to evaluate resources and programs available
in other states, with a report to the Study Commission on Aging by November 1, 2008.
Background 9: Study Older Adult Hearing Loss
On April 10, 2008, the Commission heard a presentation from the Department of Health and
Human Services on hearing loss for older adults. Based on NC demographic information, the
Department of Health and Human Services, Division of Services for the Deaf and the Hard of
Hearing, estimated " the current hearing loss population among senior adults to be 166,420 for ages
65- 74 with a projected increase in 2030 to 342,897. For senior adults ages 75 and up, current
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 36
numbers indicate 207,483 persons with hearing loss and a projected increase to 438,801 for the
year 2030." Although hearing loss occurs at all ages, the Department shared that the National
Institute on Deafness and Other Communication Disorders ( NIDCD) reports that one ( 1) out of
every three persons by age 65 has some form of hearing loss. The Department's report highlighted
a lack of readily- available and accurate information on the impact, treatment, and adaptive
technology options for individuals with hearing loss. The lack of information is compounded by
the often gradual loss of hearing.
The Department pointed out the following issues faced by older adults with hearing loss:
 " Hearing Aids and Limited Insurance Coverage- One of the first challenges that the hard of
hearing person faces is the cost of hearing aids. These devices can often cost several thousand
dollars and are rarely covered by any insurance. Generally neither Medicare nor NC
Medicaid offer hearing aid coverage for adults. North Carolina along with bordering states of
Virginia, Kentucky, South Carolina, Georgia, and Tennessee are in the list of 16 states that do
not provide this coverage. In addition, there is virtually no insurance coverage for hearing
aids in North Carolina.
 Many people report difficulty finding a trustworthy professional to assist them with hearing
aids. The lack of a 30- day mandated trial period for hearing aids in North Carolina, one of 14
states without such a policy, instills in some individuals this lower level of trust toward the
hearing health care professional.
 A myriad of emotional responses resulting from difficulties in communicating often lead to
increased mental health concerns for senior adults. Better Hearing Institute reports that
hearing loss, particularly in older individuals not using hearing aid or assistive devices, has
been directly linked to short- term memory loss, fatigue, anxiety and depression.
 Among senior adults, hearing loss is one of the most prevalent and chronic, but treatable,
disabling condition[ s]. Hearing loss is ranked third, only behind arthritis and hypertension.
Hearing loss has also been linked to lower incomes— on average, those with hearing loss but
do not wear hearing aids earn up to $ 12,000 per year less than peers using hearing aids."
The Study Commission on Aging recognizes the challenges that hearing loss presents and
recommends the enactment of 2007- SQz- 12 to require the Department of Health and Human
Services study this issue and explore ways to provide assistance to individuals with hearing loss.
Recommendation 10: Criminal Background Checks for Nursing Home Administrators
The Study Commission on Aging recommends that the General Assembly enact legislation to give
the North Carolina Board of Nursing Home Administrators the authority to require a criminal
history record check for nursing home administrator license applicants.
Background 10: Criminal Background Checks for Nursing Home Administrators
G. S. 131E- 265 provides that an offer of employment by a nursing home to an applicant to fill a
position that does not require the applicant to have an occupational license is conditioned on
consent to a criminal history record check of the applicant.
G. S. 90- 278 gives the NC State Board of Examiners for Nursing Home Administrators the
authority to issue licenses to qualified persons as nursing home administrators. Therefore, a
criminal record background check is not required for nursing home administrators because they
have an occupational license.
On April 10, 2008, the Commission heard a presentation on this issue by the North Carolina State
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 37
Board of Examiners for Nursing Home Administrators who requested the ability to perform
criminal history record checks for nursing home administrator license applicants.
The Study Commission on Aging believes that it is imperative to provide safe and secure
environments in the State's long- term care facilities and supports allowing the North Carolina State
Board of Examiners for Nursing Home Administrators to require criminal history record checks for
nursing home administrator applicants through the enactment of 2007- RDz- 26.
Recommendation 11: Support Guardianship Study Recommendations
The Study Commission on Aging recommends that the General Assembly enact legislation to
authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in
determining drivers license revocation of an incompetent individual, and to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order, which are both based
on recommendations from the House Study Committee on State Guardianship Laws to the 2007
General Assembly.
Background 11: Support Guardianship Study Recommendations
The House Study Committee on State Guardianship Laws was established by the Speaker of the
House on February 17, 2006. The Committee was directed to submit a final report on the results of
its study on or before December 31, 2006.
In the final report, Finding 6 indicates that the Committee found that guardians currently have the
authority to sell up to $ 1,500 worth of personal property without a court order in order to meet the
monetary needs of the ward. The Committee further found that the amount of a ward's personal
property that guardians are allowed to sell is outdated and insufficient. As a result, the House
Study Committee on State Guardianship recommended that the total amount of personal property
that can be sold without a court order be increased to $ 15,000. In response to this recommendation,
House Bill 794 was introduced. A Committee Substitute for House Bill 794 received a favorable
report in the House Committee on Aging and was referred to House Judiciary II. It was not heard
in House Judiciary II and House Bill 794 is not eligible for consideration during the 2008 Session.
In the final report, Finding 7 indicates that the Committee on State Guardianship Laws found it
unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an
individual who has been declared incompetent. The Committee recommended that the Division of
Motor Vehicles be authorized to not automatically revoke the drivers license of an incompetent if
the clerk of superior court recommends the incompetent be allowed to retain the drivers license. In
response to this recommendation, House Bill 796 was introduced. House Bill 796 received a
favorable report in the House Committee on Aging and was referred to House Judiciary II. It was
not heard in House Judiciary II and House Bill 796 is not eligible for consideration during the 2008
Session.
On April 10, the Commission heard a presentation on guardianship and on the issues surrounding
an increase in the amount of a ward's personal property that a guardian can sell, and on the
automatic revocation of the driver license of an incompetent.
The Study Commission on Aging supports the work of the House Study Committee on State
Guardianship Laws and recommends the enactment of 2007- SHz- 27 to address drivers license
revocation of an incompetent individual, and enactment of 2007- SHz- 28 to raise the ceiling on the
amount of personal property a guardian is allowed to sell without court order.
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 38
Recommendation 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommends that the General Assembly enact House Bill 93,
Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to
study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines
for the installation and use of wheelchair tie- down systems, and to report findings and
recommendations to the Study Commission on Aging and the Joint Legislative Transportation
Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and
was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)
Background 12: Study Safe Transport of Passengers in Wheelchairs
The Study Commission on Aging recommended that the 2007 General Assembly direct the
Department of Transportation to study appropriate methods of transporting passengers seated in
wheelchairs, to develop guidelines for the installation and use of wheelchair tiedown systems, and
to report findings and recommendations to the Study Commission on Aging and the Joint
Legislative Transportation Oversight Committee. House Bill 93 and Senate Bill 57 were
introduced. House Bill 93 was referred to the Senate Committee on Transportation on March 13,
2007 and is still eligible for consideration during the 2008 Session.
This recommendation to the 2007 Session was based on a wheelchair transportation safety
restraints presentation made to the Commission on November 15, 2006. During the presentation,
the Commission learned that transportation of passengers seated in wheelchairs within motor
vehicles is a relatively new experience and that while certified passenger restraint systems are
mandated for adults and children seated in vans, there is no law regulating restraint systems for
persons seated in wheelchairs. The presentation pointed out that the majority of incidents involving
persons transported in wheelchairs occur during ordinary driving maneuvers without a collision.
Statistical tabulations often omit these events since police are rarely summoned and the injured are
driven for medical care by the vehicle operator. However, the Division of Facility Services
tabulates incident reports filed by nursing homes which yields the following insights: problems
occur despite well- intentioned efforts to secure the chairs and apply restraints; van operators lack
knowledge that wheelchairs must be specifically designed for use in vehicles, restraint systems
must be property attached to the chair, and restraint systems must be property applied to the
passenger seated in the chair; and finally, the situation resembles that of child safety restraints.
The report distributed to the Commission included letters from the following entities expressing
support for exploring the safe transport of individuals in wheelchairs: The University of North
Carolina Highway Safety Research Center, NC Health Care Facilities Association, AARP of North
Carolina, NC Coalition on Aging, the Governor's Advisory Council on Aging, and the Senior Tar
Heel Legislature.
The presentation offered the following solutions from research by the University of Michigan
Traffic Research Institute:
1) Whenever possible, transfer the rider to a seat and use the seatbelt.
2) If transfer to a seat is not possible, use a wheelchair and tiedown system that protects the
occupant.
a. Use a Transit Wheelchair ( WC/ 19 compliant) with securement points for tiedown
straps, arm rests that permit the lap belt to cross the pelvis and a shoulder strap to
cross the chest.
b. Secure the wheelchair to the vehicle with four tiedown straps.
Apply both lap and shoulder belts to the rider. The seatbelt must fit snugly cross the
pelvis and be anchored at a 45 degree angle on each side. The shoulder strap must be
North Carolina Study Commission on Aging
Report to the Governor and the 2008 Session of the 2007 General Assembly 39
in contact with the middle of the chest and shoulder and it must avoid contact with the
neck.
The Study Commission on Aging continues to support House Bill 93, a recommendation to the
2007 Session of the General Assembly, which requires a study of appropriate methods of
transporting passengers seated in wheelchairs.
Recommendation 13: Study Medically Needy Income Standard
The Study Commission on Aging recommends that the General Assembly enact House Bill 92,
Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,
Division of Medical Assistance, to study the medically needy income standard and determine the
best method of increasing the standard while providing improved consistency across long- term care
settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate
Appropriations and was a recommendation to the 2007 General Assembly from the Study
Commission on Aging.)
Background 13: Study Medically Needy Income Standard
The Study Commission on Aging recommended that the 2007 General Assembly direct the
Department of Health and Human Services to review options for increasing Medicaid Medically
Needy Income Limits. House Bill 92 and Senate Bill 110 were introduced. House Bill 92 was
referred to the Senate Committee on Appropriations on March 14, 2007 and is still eligible for
consideration during the 2008 Session.
This recommendation to the 2007 Session was based on presentations to the Commission on the
Medicaid Institutional Bias Study. The study was mandated by Section 10.3 of S. L. 2004- 124 for
the purpose of identifying any bias that favors support for individuals in institutional settings over
support for individuals living at home.
In response to a Commission recommendation, S. L. 2006- 110 was enacted and required the
Department of Health and Human Services to collaborate with providers and advocates of home
and community- based long- term care services to review the Institutional Bias Report and make
recommendations on ways to address the identified biases. On December 13, 2006, the
Commission heard a presentation on recommendations to address two of the biases. One of the
identified biases stated that medically needy requirements leave little money for persons to pay for
living expenses if they prefer to remain in the community, whi